The Effect of Arthroscopic Surgery for Degenerative Meniscus Tears: A Metaanalysis
ZHOU Jianguo, ZHOU Huachao, ZHANG Wu, SUN Jingfeng
1.Department of Orthopaedics, Traditional Chinese Medical Hospital of Pukou District of Nanjing, Nanjing 211800, Jiangsu, China; 2. Shandong Zaozhuang Hospital of Zaozhuang Mining Group, Zaozhuang 277101, Shandong, China; 3. Department of General Surgery, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, Jiangsu, China
Abstract: ObjectiveTo evaluate the effect of arthroscopic surgery for degenerative meniscus tears.MethodsThe correlated literatures of cohort study and prospective control study on the arthroscopic surgery for treating the degenerative meniscus tears with Jadad scored 4 above were retrieved in MEDLINE, PUBMED, EMBASE and WOS database from 2007 to 2014. The effect (pain score) of shortterm (6mon after surgery) and longterm (24mon after surgery) were evaluated by metaanalysis.ResultsThere were 9 studies adopted in the metaanalysis. The knee joint function was evaluated after the arthroscopic surgery for degenerative meniscus tears: ①The functional outcomes of shortterm showed SMD=0.32, 95%CI(0.19-0.45), P=0.000, and there was significant difference; In the stratification analysis of European cases, there was SMD=0.31, 95%CI(0.11-0.52), P=0.003, and the difference was statistical significance; In the stratification analysis of Asian cases, there was SMD=0.32, 95%CI(0.15-0.49), P=0.000, and the difference was statistical significance. ②The functional outcomes of longterm revealed SMD=0.10, 95%CI(-0.03-0.24), P=0.125, and there was no statistical difference; In the European patients, there was SMD=0.22, 95%CI(0.03-0.41), P=0.021, and the difference was statistical significance； In the Asian patients, there was SMD=-0.01, 95%CI(-0.20-0.17), P=0.880, and the difference was not statistical significance.ConclusionThe arthroscopic surgery can improve the knee joint function and pain for degenerative meniscus tears in shortterm, but not in longterm.
周建国1，周华朝2，张武2，孙静锋3. 关节镜手术改善半月板退行性撕裂伤疼痛的荟萃分析[J]. 中国现代手术学杂志, 2017, 21(1): 31-35.
ZHOU Jianguo, ZHOU Huachao, ZHANG Wu, SUN Jingfeng. The Effect of Arthroscopic Surgery for Degenerative Meniscus Tears: A Metaanalysis. Chinese Journal of Modern Operative Surgery, 2017, 21(1): 31-35.
Kim S, Bosque J, Meehan JP, et al. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006［J］. J Bone Joint Surg Am, 2011, 93(11):9941000. doi: 10.2106/JBJS.I.01618.
［2］
Lee DW, Kim MK, Jang HS, et al. Clinical and radiologic evaluation of arthroscopic medial meniscus root tear refixation: comparison of the modified MasonAllen stitch and simple stitches［J］. Arthroscopy, 2014, 30(11):14391446. doi: 10.1016/j.arthro.2014.05.029.
［3］
Stensrud S, Risberg MA, Roos EM. Effect of exercise therapy compared with arthroscopic surgery on knee muscle strength and functional performance in middleaged patients with degenerative meniscus tears: a 3mo followup of a randomized controlled trial［J］. Am J Phys Med Rehabil, 2015, 94(6):460473. doi: 10.1097/PHM.0000000000000209.
［4］
Herrlin S, Ha llander M, Wange P, et al. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial［J］. Knee Surg Sports Traumatol Arthrosc, 2007, 15(4):393401.
［5］
ster as H, ster as B, Torstensen TA. Medical exercise therapy, and not arthroscopic surgery, resulted in decreased depression and anxiety in patients with degenerative meniscus injury［J］. J Bodyw Mov Ther, 2012, 16(4):456463. doi: 10.1016/j.jbmt.2012.04.003.
［6］
Herrlin SV, Wange PO, Lapidus G, et al. Is arthroscopic surgery beneficial in treating nontraumatic, degenerative medial meniscal tears? A five year followup［J］. Knee Surg Sports Traumatol Arthrosc, 2013, 21(2):358364. doi: 10.1007/s0016701219603.
［7］
Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis［J］. N Engl J Med, 2013, 368(18):16751684. doi: 10.1056/NEJMoa1301408.
［8］
Sihvonen R, Paavola M, Malmivaara A, et al. Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear［J］. N Engl J Med, 2013, 369(26):25152524. doi: 10.1056/NEJMoa1305189.
［9］
Vermesan D, Prejbeanu R, Laitin S, et al. Arthroscopic debridement compared to intraarticular steroids in treating degenerative medial meniscal tears［J］. Eur Rev Med Pharmacol Sci, 2013, 17(23):31923196.
［10］
Yim JH, Seon JK, Song EK, et al. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus［J］. Am J Sports Med, 2013, 41(7):15651570. doi: 10.1177/0363546513488518.
［11］
Bannuru RR, Vaysbrot EE, McIntyre LF. Did the American Academy of Orthopaedic Surgeons osteoarthritis guidelines miss the mark?［J］. Arthroscopy, 2014, 30(1):8689. doi: 10.1016/j.arthro.2013.10.007.
［12］
Feucht MJ, Grande E, Brunhuber J, et al. Biomechanical evaluation of different suture materials for arthroscopic transtibial pullout repair of posterior meniscus root tears［J］. Knee Surg Sports Traumatol Arthrosc, 2015, 23(1):132139. doi: 10.1007/s001670132656z.
［13］
Cho JH, Song JG. Secondlook arthroscopic assessment and clinical results of modified pullout suture for posterior root tear of the medial meniscus［J］. Knee Surg Relat Res, 2014, 26(2):106113. doi: 10.5792/ksrr.2014.26.2.106.
［14］
Engelhart L, Nelson L, Lewis S, et al. Validation of the Knee Injury and Osteoarthritis Outcome Score subscales for patients with articular cartilage lesions of the knee［J］. Am J Sports Med, 2012, 40(10):22642272.
［15］
Singh JA, Luo R, Landon GC, et al. Reliability and clinically important improvement thresholds for osteoarthritis pain and function scales: a multicenter study［J］. J Rheumatol, 2014, 41(3):509515. doi: 10.3899/jrheum.130609.
2017, Vol. 21 
