Background:

Meniscus root tears (MRTs) are defined as radial tears within 1 cm of the meniscus root insertion or an avulsion of the meniscus root itself. They lead to altered joint loading because of the failure to convert axial (compressive) loads into hoop stresses. Untreated MRTs can result in altered joint biomechanics and accelerated articular cartilage degeneration and the development of osteoarthritis (OA), yet optimal management remains unclear.

Purpose:

To review treatment outcomes after acute MRTs by surgical repair, debridement, meniscectomy, or nonoperative treatment.

Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review of the evidence from human clinical studies was conducted with electronic searches of the PUBMED, Medline, EMBASE, and the Cochrane Library databases. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed synthesis of the evidence.

Results:

Eleven studies of low to moderate methodological quality were identified. All treatment options improved functional scores after >12 months. Arthroscopic repair may be associated with better functional outcomes when compared with partial meniscectomy and nonoperative management at 12-month follow-up. Radiographic progression of OA occurred in all treatment groups; there was some evidence that this was delayed after repair when compared with other treatments. Baseline severity of meniscal extrusion, varus malalignment, and pretreatment degeneration were predictors of poor functional outcomes. Age was not found to be an independent predictor of functional outcome.

Conclusion:

The current level 3 and 4 evidence suggests that arthroscopic repair may result in slower progression of radiological deterioration compared with meniscectomy and nonoperative management. The current literature does not support the exclusion of patients from MRT repair on the basis of age. Patients undergoing acute MRT treatments (repair, debridement, or nonoperative) can be expected to experience improvement in functional outcomes after >12 months. The strength of conclusions are limited because of the paucity of high-quality studies on this subject. Further studies, preferably randomized sham controlled trials with function-oriented rehabilitation programs, are needed to compare treatment strategies and stratification of care based on the risk of meniscal extrusion.

Registration:

CRD42018085092 (PROSPERO).

中文翻译：

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急性半月板根撕裂修复的结果是否优于清创或非手术治疗？系统评价

背景：

半月板根撕裂 (MRT) 定义为半月板根插入 1 厘米内的径向撕裂或半月板根本身的撕脱。由于未能将轴向（压缩）载荷转化为环向应力，它们会导致关节载荷发生变化。未经治疗的 MRT 可导致关节生物力学改变和加速关节软骨退化以及骨关节炎 (OA) 的发展，但最佳管理仍不清楚。

目的：

审查通过手术修复、清创、半月板切除术或非手术治疗急性 MRT 后的治疗结果。

设计：

系统审查；证据水平，4。

方法：

通过对 PUBMED、Medline、EMBASE 和 Cochrane 图书馆数据库的电子搜索，对来自人类临床研究的证据进行了系统评价。一名审查员提取数据，两名审查员评估偏倚风险并进行证据综合。

结果：

确定了 11 项方法学质量从低到中等的研究。所有治疗方案均在 >12 个月后改善了功能评分。在 12 个月的随访中，与部分半月板切除术和非手术治疗相比，关节镜修复可能与更好的功能结果相关。所有治疗组均出现 OA 影像学进展；有一些证据表明，与其他治疗相比，修复后延迟。半月板挤压、内翻畸形和治疗前退化的基线严重程度是功能结果不佳的预测因素。没有发现年龄是功能结果的独立预测因素。

结论：

目前的 3 级和 4 级证据表明，与半月板切除术和非手术治疗相比，关节镜修复可能会导致放射学恶化的进展较慢。目前的文献不支持根据年龄将患者排除在 MRT 修复之外。接受急性 MRT 治疗（修复、清创或非手术）的患者预计在 >12 个月后功能结果会有所改善。由于缺乏关于该主题的高质量研究，结论的强度有限。需要进一步的研究，最好是具有功能导向康复计划的随机假对照试验，以比较基于半月板挤压风险的治疗策略和护理分层。

登记：

CRD42018085092 (PROSPERO)。