Objective To investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction. Design Prognosis systematic review (PROSPERO registration number CRD42016036788). Methods We searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google Scholar from inception to 3rd May 2018. Eligible articles included patients with ACL injury (diagnosis confirmed by MRI and/or diagnostic arthroscopy), reported the number of meniscal tears at the time of ACL injury diagnosis/start of treatment and reported the number of new meniscal tears that subsequently occurred. Articles with fewer than 20 patients at follow-up, and articles limited to ACL revision surgery or multi-ligament knee injuries were excluded. Two independent reviewers screened articles, assessed eligibility, assessed risk of bias and extracted data. We judged the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology. Results Of 75 studies included in the systematic review, 54 studies with 9624 patients and 501 new meniscal tears were appropriate for quantitative analysis. Heterogeneity precluded data pooling. The risk of new meniscal tears was 0%–21% when follow-up was <2 years, 0%–29% when follow-up was 2 to 5 years, 5%–52% when follow-up was 5 to 10 years and 4%–31% when follow-up was longer than 10 years. The proportion of studies with high risk of selection, misclassification and detection bias was 84%, 69% and 68%, respectively. Certainty of evidence was very low. Conclusion New meniscal tears occurred in 0%–52% of patients between 4 months and 20 years (mean 4.9±4.4 years) following treatment for ACL injury. The certainty of evidence was too low to guide surgical treatment decisions. This review cannot conclude that the incidence of new meniscal tears is lower if ACL injury is treated with surgery compared with treatment with rehabilitation only.

中文翻译：

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证据太弱，无法指导前交叉韧带损伤的手术治疗决策：前交叉韧带损伤后新半月板撕裂风险的系统评价

目的 探讨前交叉韧带 (ACL) 损伤治疗后新发半月板撕裂的风险，儿童和成人进行和未进行 ACL 重建。设计预后系统评价（PROSPERO 注册号 CRD42016036788）。方法 我们检索了 Embase、Ovid Medline、Cochrane、CINAHL、SPORTDiscus、PEDro 和 Google Scholar 从成立到 2018 年 5 月 3 日。符合条件的文章包括 ACL 损伤患者（通过 MRI 和/或诊断性关节镜检查确诊），报告了半月板撕裂的数量在 ACL 损伤诊断/治疗开始时，并报告随后发生的新半月板撕裂的数量。随访时患者少于 20 人的文章，以及仅限于 ACL 翻修手术或多韧带膝关节损伤的文章被排除在外。两位独立审稿人筛选文章，评估资格，评估偏倚风险并提取数据。我们使用推荐分级评估发展和评估 (GRADE) 工作组方法来判断证据的确定性。结果 在纳入系统评价的 75 项研究中，54 项研究 9624 例患者和 501 例新半月板撕裂适合定量分析。异质性排除了数据池化。随访 <2 年时新发半月板撕裂的风险为 0%–21%，随访 2-5 年时为 0%-29%，随访 5-10 年时为 5%-52%当随访时间超过 10 年时为 4%–31%。具有高选择、错误分类和检测偏倚风险的研究比例分别为 84%、69% 和 68%。证据的质量非常低。结论 ACL 损伤治疗后 4 个月至 20 年（平均 4.9±4.4 年）期间，0%~52% 的患者出现新的半月板撕裂。证据的质量太低，无法指导手术治疗决策。该评价不能得出结论，与仅通过康复治疗相比，如果 ACL 损伤通过手术治疗，新半月板撕裂的发生率较低。