Pearsall Christian A, Desai Sohil S, Athanasian Christian, Piasecki Dana P, Saltzman Bryan M, Swindell Hasani, Trofa David P
Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.
OrthoCarolina, Charlotte, North Carolina, USA.
Am J Sports Med. 2025 Jul;53(9):2255-2263. doi: 10.1177/03635465241279844. Epub 2025 Jan 12.
Limited biomechanical evidence exists describing how horizontal meniscus tears (HMTs), meniscal repair (MR), and meniscectomy alter the knee's biomechanical environment.
To evaluate changes in knee contact mechanics following HMTs, MR, and meniscectomy.
Systematic review; Level of evidence, 5.
PubMed, EMBASE, and CINAHL databases were systematically searched for biomechanical cadaveric studies of HMTs up to January 16, 2023, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that (1) did not examine MRs or meniscectomies, (2) did not report contact area (CA) or pressure, (3) involved concomitant injuries (eg, anterior cruciate ligament tear), (4) were nonbiomechanical studies (eg, review, technique, and clinical), and (5) were non-English language articles were excluded. The endpoints were peak contact pressure (PCP) and mean CA.
Out of 1526 initial results, 6 studies were included for final review. PCP and CA were measured in 59 intact menisci, 59 HMTs, 59 partial meniscectomies (PM), 59 complete meniscectomies (CM), and 33 MR. Among all HMTs versus the intact state, pooled PCP increased by 14.2%, and pooled CA decreased by 7.1%. Among all PMs versus the intact state, 4 of 6 studies found significantly increased PCP (27.1%), and 5 found significantly reduced CA (22.1%). Among all CMs versus the intact state, all 6 studies found significantly increased PCP (54.5%), and 5 found significantly reduced CA (33%). Among the 3 studies directly comparing PM to CM, 2 studies found PM to have significantly smaller increases in PCP (23.3% vs 52.4%) and significantly smaller reductions in CA (16.7% vs 28.1%) from the intact state.) The 3 studies evaluating MR versus the intact state found no significant difference in PCP or CA.
After an HMT, MR had the smallest deviations in contact mechanics; only MR restored contact mechanics to the uninjured state. These findings support MR's superiority, illustrate that maintaining contact mechanics requires preserving meniscal tissue, and are consistent with clinical evidence. More clinical comparisons are needed to understand the differences among treatments.
关于水平半月板撕裂（HMT）、半月板修复（MR）和半月板切除术如何改变膝关节生物力学环境的生物力学证据有限。
评估HMT、MR和半月板切除术后膝关节接触力学的变化。
系统评价；证据等级为5级。
按照PRISMA（系统评价和荟萃分析的首选报告项目）指南，对PubMed、EMBASE和CINAHL数据库进行系统检索，以查找截至2023年1月16日的HMT生物力学尸体研究。排除以下研究：（1）未检查MR或半月板切除术；（2）未报告接触面积（CA）或压力；（3）涉及合并损伤（如前交叉韧带撕裂）；（4）为非生物力学研究（如综述、技术和临床研究）；（5）为非英文文章。终点指标为峰值接触压力（PCP）和平均CA。
在1526项初始结果中，6项研究纳入最终评价。对59个完整半月板、59个HMT、59个部分半月板切除术（PM）、59个完全半月板切除术（CM）和33个MR测量了PCP和CA。在所有HMT与完整状态相比时，汇总PCP增加了14.2%，汇总CA减少了7.1%。在所有PM与完整状态相比时，6项研究中的4项发现PCP显著增加（27.1%），5项发现CA显著减少（22.1%）。在所有CM与完整状态相比时，所有6项研究均发现PCP显著增加（54.5%），5项发现CA显著减少（33%）。在3项直接比较PM与CM的研究中，2项研究发现PM从完整状态起PCP的增加幅度显著较小（23.3%对52.%)，CA的减少幅度也显著较小（16.7%对28.1%）。3项评估MR与完整状态相比的研究发现PCP或CA无显著差异。
HMT后，MR在接触力学方面的偏差最小；只有MR能将接触力学恢复到未受伤状态。这些发现支持了MR的优越性，表明维持接触力学需要保留半月板组织，且与临床证据一致。需要更多的临床比较来了解不同治疗方法之间的差异。
