Biomechanical Properties of Meniscal Repair Versus Meniscectomy for Horizontal Meniscal Tears: A Systematic Review

Christian A. Pearsall, Sohil S. Desai, Christian Athanasian, Dana P. Piasecki, Bryan M. Saltzman, Hasani Swindell, David P. Trofa
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Abstract

Background:Limited biomechanical evidence exists describing how horizontal meniscus tears (HMTs), meniscal repair (MR), and meniscectomy alter the knee's biomechanical environment.Purpose:To evaluate changes in knee contact mechanics following HMTs, MR, and meniscectomy.Study Design:Systematic review; Level of evidence, 5.Methods:PubMed, EMBASE, and CINAHL databases were systematically searched for biomechanical cadaveric studies of HMTs up to January 16, 2023, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that (1) did not examine MRs or meniscectomies, (2) did not report contact area (CA) or pressure, (3) involved concomitant injuries (eg, anterior cruciate ligament tear), (4) were nonbiomechanical studies (eg, review, technique, and clinical), and (5) were non-English language articles were excluded. The endpoints were peak contact pressure (PCP) and mean CA.Results:Out of 1526 initial results, 6 studies were included for final review. PCP and CA were measured in 59 intact menisci, 59 HMTs, 59 partial meniscectomies (PM), 59 complete meniscectomies (CM), and 33 MR. Among all HMTs versus the intact state, pooled PCP increased by 14.2%, and pooled CA decreased by 7.1%. Among all PMs versus the intact state, 4 of 6 studies found significantly increased PCP (27.1%), and 5 found significantly reduced CA (22.1%). Among all CMs versus the intact state, all 6 studies found significantly increased PCP (54.5%), and 5 found significantly reduced CA (33%). Among the 3 studies directly comparing PM to CM, 2 studies found PM to have significantly smaller increases in PCP (23.3% vs 52.4%) and significantly smaller reductions in CA (16.7% vs 28.1%) from the intact state.) The 3 studies evaluating MR versus the intact state found no significant difference in PCP or CA.Conclusion:After an HMT, MR had the smallest deviations in contact mechanics; only MR restored contact mechanics to the uninjured state. These findings support MR's superiority, illustrate that maintaining contact mechanics requires preserving meniscal tissue, and are consistent with clinical evidence. More clinical comparisons are needed to understand the differences among treatments.
半月板修复与半月板切除术治疗水平半月板撕裂的生物力学特性:系统综述
背景:有限的生物力学证据描述了水平半月板撕裂(hmt)、半月板修复(MR)和半月板切除术如何改变膝关节的生物力学环境。目的:评价hmt、MR和半月板切除术后膝关节接触力学的变化。研究设计:系统评价;证据等级,5。方法:使用PRISMA(系统评价和荟萃分析首选报告项目)指南,系统检索PubMed、EMBASE和CINAHL数据库,检索截至2023年1月16日的hmt生物力学尸体研究。(1)未检查MRs或半月板切除术的研究,(2)未报告接触面积(CA)或压力的研究,(3)涉及伴随损伤的研究(如前十字韧带撕裂),(4)非生物力学研究(如综述、技术和临床),以及(5)非英语文献均被排除。终点是峰值接触压力(PCP)和平均ca。结果:在1526项初始结果中,6项研究被纳入最终审查。在59例完整半月板、59例半月板切除术、59例半月板部分切除术(PM)、59例半月板完全切除术(CM)和33例半月板mr中测量了PCP和CA。与完整半月板切除术相比,所有半月板切除术的PCP增加了14.2%,CA减少了7.1%。在所有pm与完整状态相比,6项研究中有4项发现PCP显著增加(27.1%),5项发现CA显著降低(22.1%)。在所有CMs与完整状态相比,所有6项研究均发现PCP显著增加(54.5%),5项研究发现CA显著降低(33%)。在直接比较PM与CM的3项研究中,2项研究发现PM在完整状态下PCP的增加明显较小(23.3%对52.4%),CA的减少明显较小(16.7%对28.1%)。3项评估MR与完整状态的研究发现PCP或ca无显著差异。结论:HMT后MR在接触力学上的偏差最小;只有MR将接触力学恢复到未损伤状态。这些发现支持MR的优越性,说明维持接触力学需要保留半月板组织,并且与临床证据一致。需要更多的临床比较来了解治疗之间的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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