Elnewishy Ahmed, Elsenosy Abdelfatah M, Nahas Sam, Abdalla Mohammad, Symeon Naoum, Teama Hagar
Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, GBR.
Trauma and Orthopaedics, University Hospitals Dorset, Poole, GBR.
Cureus. 2024 Dec 6;16(12):e75199. doi: 10.7759/cureus.75199. eCollection 2024 Dec.
Medial meniscus root tears (MMRTs) are serious injuries that disrupt knee biomechanics, often accelerating cartilage degeneration and osteoarthritis when left untreated. These injuries are increasingly recognized as a major cause of knee pain and functional limitations, particularly among middle-aged and older adults. This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management compared to surgical intervention for MMRT, focusing on pain relief, functional recovery, and the progression of osteoarthritis. A thorough search of PubMed, Scopus, Google Scholar, and the Cochrane Library identified six studies that directly compared surgical repair, primarily transtibial pull-out repair, with conservative management. Outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score, and the International Knee Documentation Committee (IKDC) subjective score. Surgical intervention showed marked superiority in KOOS scores, with a standardized mean difference (SMD) of 1.42 (95% CI: 0.97 to 1.88, P < 0.00001), reflecting significant improvements in pain, daily function, and quality of life. However, pooled analyses for the Lysholm score (SMD: 0.21, 95% CI: -0.23 to 0.65, P = 0.35) and IKDC score (SMD: 0.12, 95% CI: -0.56 to 0.80, P = 0.73) did not show statistically significant differences between treatments. High heterogeneity (I² > 50%) was noted, likely due to differences in study populations, follow-up periods, and methodologies. These results suggest that surgical repair offers superior pain relief and functional benefits for MMRT compared to conservative management, positioning it as the preferred option for most patients. Nonetheless, conservative management may remain suitable for certain patients, particularly those with contraindications to surgery. Further high-quality, long-term research is essential to confirm these findings and inform clinical decision-making.
内侧半月板根部撕裂（MMRTs）是严重损伤，会破坏膝关节生物力学，若不治疗，常加速软骨退变和骨关节炎进程。这些损伤越来越被认为是膝关节疼痛和功能受限的主要原因，尤其是在中老年人中。本系统评价和荟萃分析旨在评估与手术干预相比，MMRT保守治疗的效果，重点关注疼痛缓解、功能恢复和骨关节炎进展。对PubMed、Scopus、谷歌学术和考克兰图书馆进行全面检索，确定了六项直接比较手术修复（主要是经胫骨拉出修复）与保守治疗的研究。结局指标包括膝关节损伤和骨关节炎结局评分（KOOS）、Lysholm评分以及国际膝关节文献委员会（IKDC）主观评分。手术干预在KOOS评分方面显示出明显优势，标准化均数差（SMD）为1.42（95%CI：0.97至1.88，P<0.00001），反映出疼痛、日常功能和生活质量有显著改善。然而，Lysholm评分（SMD：0.21，95%CI：-0.23至0.65，P=0.35）和IKDC评分（SMD：0.12，95%CI：-0.56至0.80，P=0.73）的汇总分析未显示治疗组间有统计学显著差异。观察到高度异质性（I²>50%），可能是由于研究人群、随访期和方法的差异。这些结果表明，与保守治疗相比，手术修复为MMRT提供了更好的疼痛缓解和功能益处，使其成为大多数患者的首选方案。尽管如此，保守治疗可能仍适用于某些患者，尤其是那些有手术禁忌证的患者。进一步的高质量、长期研究对于证实这些发现并为临床决策提供依据至关重要。
