■半月板修复已成为半月板撕裂的首选治疗方法,尤其是在桶柄半月板撕裂(BHMT)的子集中。然而,无法获得相应故障率的综合估计,因此对这些眼泪的治愈潜力保持怀疑。此外,已经报道了多种预测高失败率的因素,但证据相互矛盾.
■为了确定文献报道的BHMT关节镜修复后的故障率,将其与从相同研究中提取的简单半月板撕裂的失败率进行比较,并分析先前报道的预测半月板修复失败的因素的影响。
■系统评价和荟萃分析;证据水平,4.
■由2名独立审阅者使用主要书目数据库进行了系统搜索(PubMed,Scopus,科克伦图书馆,和EMBASE)。在逐步排除过程之后,38条符合纳入标准。故障率数据采用随机效应比例荟萃分析(根据个体研究规模加权)进行分析,和森林地块被构建以确定BHMT与简单泪液之间的任何统计学显著差异(纵向,径向,或水平),内侧与外侧BHMT,孤立手术与伴随前交叉韧带重建的修复,红红区和红白区的眼泪。此外,进行了荟萃回归分析,以评估患者年龄和性别的影响,缝合技术(内部或内部),从受伤到手术的时间,平均针数,以及失败率的随访时间。
■合并失败率为14.8%(95%CI,11.3%-18.3%;I2=77.2%)。共有17项研究提供了BHMT维修(46/311维修)和简单撕裂维修(54/546维修)的故障率,证明BHMT修复的故障率显著较高(风险比[RR]=1.50;95%CI,1.05-2.15;I2=0%;P=0.03)。中期BHMT维修(RR=1.94;95%CI,1.25-3.01;I2=0%;P=.003)和单独维修(RR=1.77;95%CI,1.15-2.72;I2=0%;P=.009)具有较高的失效风险,但在红红区和红白区的泪液之间没有发现统计学上的显著差异.在用元回归评估的其他因素中,只有平均针数对故障率有统计学显著影响.
■根据现有文献,本系统综述对关节镜下BHMT修复后的失败率进行了合理全面的分析;估计有14.8%的病例发生失败.中等撕裂和孤立的维修是失败的2个主要预测因素。
UNASSIGNED: Meniscal repair has become the treatment of choice for meniscal tears, especially in the subset of bucket-handle meniscal tears (BHMTs). However, a comprehensive estimate of the corresponding failure rate is not available, thus maintaining doubts about the healing potential of these tears. Furthermore, a wide range of factors to predict high failure rates have been reported but with conflicting evidence.
UNASSIGNED: To determine the failure rate after arthroscopic repair of BHMTs as reported in the literature, compare this with the failure rate of simple meniscal tears extracted from the same studies, and analyze the influence of factors previously reported to be predictive of meniscal repair failure.
UNASSIGNED: Systematic review and meta-analysis; Level of evidence, 4.
UNASSIGNED: A systematic search was conducted by 2 independent reviewers using principal bibliographic databases (PubMed, Scopus, Cochrane Library, and EMBASE). After a stepwise exclusion process, 38 articles met the inclusion criteria. Failure rate data were analyzed with a random-effects proportional meta-analysis (weighted for individual study size), and forest plots were constructed to determine any statistically significant differences between BHMTs versus simple tears (longitudinal, radial, or horizontal), medial versus lateral BHMTs, isolated procedures versus repairs with concomitant anterior cruciate ligament reconstruction, and tears in red-red versus red-white zones. Moreover, a meta-regression analysis was conducted to evaluate the effect of patient age and sex, suture technique (in-out or all-inside), time from injury to surgery, mean number of stitches, and length of follow-up on failure rates.
UNASSIGNED: The pooled failure rate was 14.8% (95% CI, 11.3%-18.3%; I2 = 77.2%). A total of 17 studies provided failure rates of both BHMT repairs (46/311 repairs) and simple tear repairs (54/546 repairs), demonstrating a significantly higher failure rate for BHMT repairs (risk ratio [RR] = 1.50; 95% CI, 1.05-2.15; I2 = 0%; P = .03). Medial BHMT repairs (RR = 1.94; 95% CI, 1.25-3.01; I2 = 0%; P = .003) and isolated repairs (RR = 1.77; 95% CI, 1.15-2.72; I2 = 0%; P = .009) had statistically higher risk of failure, but no statistically significant difference was found between tears in red-red versus red-white zones. Among the other factors evaluated with meta-regression, only the mean number of stitches showed a statistically significant effect on failure rates.
UNASSIGNED: Based on the currently available literature, this systematic review provides a reasonably comprehensive analysis of failure rate after arthroscopic BHMT repair; failure is estimated to occur in 14.8% of cases. Medial tears and isolated repairs were the 2 major predictors of failure.