内侧半月板后根修复联合胫骨高位截骨治疗膝内翻性关节炎的有限临床疗效：一项系统回顾和荟萃分析

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-09-22 DOI:10.1002/jeo2.70431

Gabriele Cortina, Stefano Mauro Antuofermo, Giuseppe Francesco Papalia, Raffaele Cortina, Vincenzo Condello, Simone Perelli, Joan Carles Monllau, Vincenzo Madonna

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引用次数: 0

摘要

内侧半月板后根撕裂（MMPRTs）在生物力学上与全半月板切除术相当，导致半月板挤压、胫股接触压力增加和内翻膝关节骨关节炎（OA）加速。虽然胫骨高位截骨术（HTO）可以有效地卸载内侧间室，但在HTO期间修复MMPRT的附加价值仍存在争议。本系统综述和荟萃分析旨在评估MMPRT修复和HTO联合是否比单独HTO提供更好的短期临床和放射学结果。方法于2025年3月系统检索PubMed、Cochrane和Scopus。对膝内翻和内侧骨性关节炎患者同时进行MMPR修复或不进行MMPR修复的HTO进行了比较研究。主要结果包括临床评分（国际膝关节文献委员会[IKDC]、Lysholm、膝关节学会评分[KSS]和特殊外科医院[HSS]）、影像学参数（关节线会聚角[JLCA]、髋关节-膝关节-踝关节[HKA]角度和关节间隙宽度）、半月板挤压和二次关节镜检查结果。采用Review Manager 5.4随机效应模型进行统计分析。结果8项回顾性比较研究（n = 630例）符合纳入标准。与单独使用HTO相比，MMPRT修复联合HTO的IKDC评分在统计学上更高（MD = 3.56, p = 0.001）；然而，在Lysholm、KSS功能和HSS评分方面，两组间无显著差异。影像学上，JLCA的改善很小（MD = - 0.25; p = 0.006），没有明确的临床意义。各组间半月板挤压无显著差异（MD = 0.30; p = 0.72）。二次关节镜检查显示22%的病例牙根完全愈合。偏倚风险为中等至高。结论短期随访显示，MMPRT联合HTO治疗可获得更好的IKDC临床评分。此外，在常规临床实践中，MMPRT修复与HTO结合的实际益处值得怀疑。需要更长随访时间的前瞻性研究来阐明MM的长期临床影响。证据水平III级，系统评价和荟萃分析。

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Limited clinical benefit of medial meniscus posterior root repair combined with high tibial osteotomy in varus knee osteoarthritis: A systematic review and meta-analysis

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Limited clinical benefit of medial meniscus posterior root repair combined with high tibial osteotomy in varus knee osteoarthritis: A systematic review and meta-analysis

Purpose

Medial meniscus posterior root tears (MMPRTs) are biomechanically comparable to total meniscectomy, leading to meniscal extrusion, increased tibiofemoral contact pressure and accelerated osteoarthritis (OA) in varus-aligned knees. While high tibial osteotomy (HTO) is effective in unloading the medial compartment, the added value of repairing the MMPRT during HTO remains debated. This systematic review and meta-analysis aimed to evaluate whether combined MMPRT repair and HTO provide superior short-term clinical and radiological outcomes compared to HTO alone.

Methods

A systematic search of PubMed, Cochrane and Scopus was performed in March 2025. Comparative studies evaluating HTO with or without concurrent MMPR repair in patients with varus knee and medial OA were included. Primary outcomes were clinical scores (International Knee Documentation Committee [IKDC], Lysholm, Knee Society Score [KSS] and Hospital for Special Surgery [HSS]), radiographic parameters (joint line convergence angle [JLCA], hip–knee–ankle [HKA] angle and joint space width), meniscal extrusion and second-look arthroscopic findings. Statistical analysis was conducted using a random-effects model with Review Manager 5.4.

Results

Eight retrospective comparative studies (n = 630 patients) met the inclusion criteria. MMPRT repair plus HTO demonstrated statistically higher IKDC scores (MD = 3.56; p = 0.001) compared to HTO alone; however, there were no significant differences between groups in terms of Lysholm, KSS function and HSS scores. Radiographically, minimal improvements were noted in JLCA (MD = −0.25; p = 0.006), without clear clinical implications. Meniscal extrusion did not differ significantly between groups (MD = 0.30; p = 0.72). Second-look arthroscopy revealed complete root healing in 22% of cases. The risk of bias was moderate to high.

Conclusion

Short-term follow-up shows that combining MMPRT repair with HTO yields statistically better IKDC clinical scores. Furthermore, the actual benefit of combining MMPRT repair with HTO in routine clinical practice is questionable. Prospective studies with longer follow-up are required to clarify the long-term clinical impact of MM.