Keyhani Sohrab, Soleymanha Mehran, Vosoughi Fardis, Nikibakhsh Ali, Zadgari Ervin, Mousavi Maryam, LaPrade Robert F
Bone, Joint, and Related Tissues Research Center Akhtar Orthopedic Training and Research Hospital, Shahid Beheshti University of Medical Sciences Tehran Iran.
Department of Orthopaedic, Orthopaedic Research Center, Poursina Hospital, School of Medicine Guilan University of Medical Sciences Rasht Iran.
J Exp Orthop. 2025 Feb 10;12(1):e70169. doi: 10.1002/jeo2.70169. eCollection 2025 Jan.
The purpose of this study was to assess the efficacy of arthroscopic intervention on the treatment of pigmented villonodular synovitis (PVNS) patients, with a focus on the potential advantages of this approach in lowering the risk of disease recurrence.
We performed a systematic review and meta-analysis following the PRISMA 2020 protocol. Our search encompassed five databases, namely PubMed, Embase, Scopus, Web of Science and Cochrane Library. Statistical analysis was conducted on the extracted data by using the R ver. 4.4.0 software. This study included English-language observational studies (case series and cohort studies) published up to 31 March 2024, focusing on in vivo human subjects with at least 2 years of follow-up. Studies with less than 2 years of follow-up, non-arthroscopic treatment methods or addressing PVNS in structures other than the knee were excluded.
We identified 24 articles, comprising 7 case series and 17 cohort studies, based on title, abstract, and quality assessments. Approximately 16% (95% confidence interval [CI]: 10.4%-24.75%) of knees that underwent arthroscopic surgery were found to be at risk of recurrence. In line with our expectations, sub-group analysis comparing recurrence rates among different subtypes of PVNS found that the diffuse subtype exhibited a higher recurrence rate of 19.4% (95% CI: 10.01%-34.15%), compared to the local subtype, which had a recurrence rate of 9.5% (95% CI: 4.47%-19.01%). Based on the meta-regression analysis, no significant association was found between the recurrence rate and the publication year or patient mean age. However, there was a noticeable rise in the recurrence rate with a longer follow-up period, indicating a probable correlation between extended follow-up and increased recurrence rates.
Our findings suggest that arthroscopic surgery for PVNS, particularly for the diffuse subtype, results in a higher recurrence rate compared to the localized subtype. However, the inherent challenges in achieving complete resection through arthroscopy, particularly in cases with extensive disease involvement, may contribute to the observed recurrence rates.
Level III systematic review and meta-analysis.
本研究旨在评估关节镜干预治疗色素沉着绒毛结节性滑膜炎（PVNS）患者的疗效，重点关注该方法在降低疾病复发风险方面的潜在优势。
我们按照PRISMA 2020方案进行了系统评价和荟萃分析。我们的检索涵盖了五个数据库，即PubMed、Embase、Scopus、Web of Science和Cochrane图书馆。使用R ver. 4.4.0软件对提取的数据进行统计分析。本研究纳入了截至2024年3月31日发表的英文观察性研究（病例系列和队列研究），重点关注至少随访2年的人体受试者。随访时间少于2年、非关节镜治疗方法或研究膝关节以外结构的PVNS的研究被排除。
基于标题、摘要和质量评估，我们确定了24篇文章，包括7个病例系列和17个队列研究。接受关节镜手术的膝关节中，约16%（95%置信区间[CI]：10.4%-24.75%）有复发风险。与我们的预期一致，比较PVNS不同亚型复发率的亚组分析发现，弥漫性亚型的复发率较高，为19.4%（95%CI：10.01%-34.15%），而局限性亚型的复发率为9.5%（95%CI：4.47%-19.01%）。基于荟萃回归分析，未发现复发率与发表年份或患者平均年龄之间存在显著关联。然而，随着随访时间延长，复发率有明显上升，表明延长随访与复发率增加之间可能存在相关性。
我们的研究结果表明，PVNS的关节镜手术，特别是弥漫性亚型，与局限性亚型相比，复发率更高。然而，通过关节镜实现完全切除的固有挑战，特别是在疾病广泛累及的情况下，可能导致了观察到的复发率。
III级系统评价和荟萃分析。
