Schoenecker Jon H, Tollefson Luke V, Solaiman Rafat H, Monson Jill K, Homan Morgan D, Dornan Grant J, Kennedy Nicholas I, Ronnblad Erik, LaPrade Robert F
Twin Cities Orthopedics, Eagan, Minnesota, USA.
Training Haus, Eagan, Minnesota, USA.
Am J Sports Med. 2025 Jun;53(7):1750-1760. doi: 10.1177/03635465241295709. Epub 2025 Jan 22.
The number of meniscal repairs being completed each year is increasing; however, the optimal, cost-effective postoperative assessment to determine the success or failure of a meniscal repair is not well known.
PURPOSE/HYPOTHESIS: The purpose of this systematic review was to identify the clinical examination testing that correlates with objective magnetic resonance imaging (MRI) or second-look arthroscopy (SLA) findings to determine an optimal clinical workup for assessing postoperative meniscal repair healing. It was hypothesized that specific clinical tests would correlate with meniscal repairs that did not heal.
Systematic review and meta-analysis; Level of evidence, 4.
This systematic review included all clinical studies investigating meniscal repairs, meniscal repair outcomes, and meniscal healing with clinical findings, MRI, and/or SLA, published in a peer-reviewed journal and with full English text available. All included studies were evaluated for bias using the Methodological Index for Non-Randomized Studies (MINORS). The clinical tests included those using "Barrett's criteria," with the assessment of effusion, joint line tenderness, locking, McMurray testing, and radiographs. This parameter has also been abbreviated to "modified Barrett's criteria" to include only joint line tenderness, effusion, and McMurray testing.
No significant correlations were found between clinical tests and MRI or SLA. A subgroup meta-analysis between Barrett's and non-Barrett's studies reported no significant subgroup differences (χ = 0.24; = .62). A meta-analysis of diagnostic accuracy using a group of 7 studies that reported on true-positive, true-negative, false-positive, and false-negative data for SLA demonstrated that only a lack of joint line tenderness had a high specificity for a healed meniscal repair, with a log diagnostic odds ratio of 2.62 (95% CI, 0.47-4.76).
This study found no significant correlation with any specific clinical test for meniscal repair healing status using postoperative MRI and/or SLA findings. However, it was found that no healing (when compared with complete or incomplete healing) on MRI and joint line tenderness should be considered when assessing the status of postoperative meniscal repair healing. In addition, a subgroup meta-analysis found that a lack of joint line tenderness was highly correlated with a healed meniscal repair.
每年完成的半月板修复手术数量在增加；然而，用于确定半月板修复成功或失败的最佳、具有成本效益的术后评估方法尚不清楚。
目的/假设：本系统评价的目的是确定与客观磁共振成像（MRI）或二次关节镜检查（SLA）结果相关的临床检查测试，以确定评估术后半月板修复愈合情况的最佳临床检查方法。假设特定的临床测试与未愈合的半月板修复相关。
系统评价和荟萃分析；证据等级，4级。
本系统评价纳入了所有在同行评审期刊上发表且有完整英文文本的临床研究，这些研究调查了半月板修复、半月板修复结果以及半月板愈合情况，并结合了临床检查结果、MRI和/或SLA。使用非随机研究方法学指数（MINORS）对所有纳入研究的偏倚进行评估。临床测试包括使用“巴雷特标准”的测试，评估积液、关节线压痛、交锁、麦克马瑞试验和X线片。该参数也被缩写为“改良巴雷特标准”，仅包括关节线压痛、积液和麦克马瑞试验。
未发现临床测试与MRI或SLA之间存在显著相关性。巴雷特研究与非巴雷特研究之间的亚组荟萃分析报告无显著亚组差异（χ² = 0.24；P = 0.62）。对一组7项报告了SLA真阳性、真阴性、假阳性和假阴性数据的研究进行诊断准确性的荟萃分析表明，只有无关节线压痛对愈合的半月板修复具有高特异性，对数诊断比值比为2.62（95%CI，0.47 - 4.76）。
本研究发现，使用术后MRI和/或SLA结果，没有任何特定临床测试与半月板修复愈合状态存在显著相关性。然而，发现在评估术后半月板修复愈合情况时，应考虑MRI显示未愈合（与完全或不完全愈合相比）以及关节线压痛情况。此外，亚组荟萃分析发现无关节线压痛与愈合的半月板修复高度相关。
