Garcia Jose Rafael, Ayala Salvador Gonzalez, Allende Felicitas, Mameri Enzo, Haynes Monique, Familiari Filippo, Geeslin Andrew G, Murray Iain, Moatshe Gilbert, Verma Nikhil N, LaPrade Robert F, Chahla Jorge
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopedics and Traumatology, Federal University of São Paulo EPM-UNIFESP, São Paulo, Brazil.
Orthop J Sports Med. 2024 Nov 1;12(11):23259671241283962. doi: 10.1177/23259671241283962. eCollection 2024 Nov.
Meniscus root tears comprise 10% to 21% of all meniscal tears. These tears alter knee biomechanics, elevating contact pressure, akin to a meniscectomy. Consequently, they are linked to advanced joint degeneration and cartilage damage in the affected compartment.
To systematically evaluate and relate the current literature describing the diagnosis and treatment strategies for meniscus root tears.
Scoping review; Level of evidence, 4.
This review was conducted following the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. Inclusion criteria encompassed English-language clinical and preclinical research, technical notes, and narrative reviews on meniscus root tears. Exclusion criteria were studies on patellar tendon rupture, studies on medial patellofemoral ligament rupture with additional knee joint ligament injuries, studies of patients <16 years old, and studies involving open fractures. The data were summarized using a descriptive analysis and a thematic analysis.
After 1425 articles were identified, 461 studies were included; 17% (n = 78) were case reports or case series, 15% (n = 71) were technical notes, 9% (n = 41) addressed aspects of diagnosis, 7% (n = 32 ) were narrative reviews, and 5% (n = 21) were systematic reviews or meta-analyses. Studies presenting original data comprised 57% (n = 262) of all included studies, and 97% of the studies were of evidence levels 3 to 5. Contributions were mainly from the United States (n = 123; 27%), Republic of Korea (n = 102; 22%), and Japan (n = 99; 21%). Many studies (n = 216; 47%) focused on the treatment and outcomes of meniscus root tears. A significant chronological surge in the quantity of studies addressing the diagnosis and treatment of meniscus root tears was evident, particularly over the past 3 years. Consensus was found regarding the definition of meniscus root tears, the advantages of early repair, and postoperative rehabilitation protocols. The variations in surgical techniques and operative strategies created the greatest amount of contention, along with clinical assessment and imaging modalities.
High-level evidence studies for diagnosing and managing meniscus root tears were scarce. A consensus has yet to be reached regarding the role of concomitant osteotomy, comparison of repair techniques, the use of a centralization stitch, patient factors affecting outcomes, and long-term outcomes of nonoperative management.
半月板根部撕裂占所有半月板撕裂的10%至21%。这些撕裂会改变膝关节生物力学，增加接触压力，类似于半月板切除术。因此，它们与患侧间室的晚期关节退变和软骨损伤有关。
系统评价并阐述目前描述半月板根部撕裂诊断和治疗策略的文献。
范围综述；证据等级，4级。
本综述按照系统评价和Meta分析优先报告条目（PRISMA）扩展版范围综述的指南进行。纳入标准包括关于半月板根部撕裂的英文临床和临床前研究、技术笔记及叙述性综述。排除标准为髌腱断裂研究、合并膝关节韧带损伤的髌股内侧韧带断裂研究、16岁以下患者的研究以及涉及开放性骨折的研究。数据采用描述性分析和主题分析进行总结。
在识别出1425篇文章后，纳入了461项研究；17%（n = 78）为病例报告或病例系列，15%（n = 71）为技术笔记，9%（n = 41）涉及诊断方面，7%（n = 32）为叙述性综述，5%（n = 21）为系统评价或Meta分析。呈现原始数据的研究占所有纳入研究的57%（n = 262），97%的研究证据等级为3至5级。贡献主要来自美国（n = 123；27%）、韩国（n = 102；22%）和日本（n = 99；21%）。许多研究（n = 216；47%）聚焦于半月板根部撕裂的治疗及结果。在半月板根部撕裂诊断和治疗的研究数量上，明显存在时间上的显著增长，尤其是在过去3年。在半月板根部撕裂的定义、早期修复的优势以及术后康复方案方面达成了共识。手术技术和手术策略的差异引发了最大的争议，临床评估和影像学检查方式也存在争议。
用于诊断和处理半月板根部撕裂的高级别证据研究稀缺。在合并截骨术的作用、修复技术比较、使用中心化缝线、影响结果的患者因素以及非手术治疗的长期结果等方面尚未达成共识。
