Failure and complication rates following meniscal all-inside and inside-out repairs: A systematic review and meta-analysis

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-09-30 DOI:10.1002/ksa.12485

Juan Bernardo Villarreal-Espinosa, Rodrigo Saad Berreta, Lucas Pallone, Jared Rubin, Felicitas Allende, Fernando Gómez-Verdejo, Zeeshan A. Khan, Melissa Carpenter, Sachin Allahabadi, Jorge Chahla

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Abstract

Purpose

This study examines failure rates, complication rates and patient-reported outcome measures (PROMs) for meniscal all-inside (AI) and inside-out (IO) repair techniques.

Methods

A systematic search was conducted on PubMed, Embase and Cochrane (inception to January 2024) assessing for Level I–III studies evaluating outcomes after meniscal repair. The primary outcome regarded differences in failure rates between AI and IO repair techniques. Secondary outcomes included a comparison of complication rates and PROMs. Quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation and Methodological Index for Non-Randomized Studies criteria. A meta-analysis was conducted for outcomes reported by more than three comparative studies.

Results

A total of 24 studies (13 studies and 912 menisci for AI vs. 17 studies and 1,117 menisci for IO) were included. The mean follow-up ranges were 22–192 months (AI) and 18.5–155 months (IO). The overall reported AI failure rate ranged from 5% to 35% compared to 0% to 25% within the IO group. When comparing meniscal repair failure rates in the setting of concomitant anterior cruciate ligament reconstruction, the AI group had a failure rate (AI: 5%–34%; IO: 0%–12.9%). The complication rate ranged from 0% to 40% for AI and 0% to 20.5% for IO. Post-operative PROM scores ranged from 81.2 to 93.8 (AI) versus 89.6 to 94 (IO) for IKDC and 4.0–7.02 (AI) versus 4.0–8.0 (IO) for Tegner. Upon pooling of six comparative studies, a significantly lower failure rate favouring the IO technique was observed (15.9% AI vs. 11.1% IO; p = 0.02), although this result was influenced by a study with a predominantly elite athlete population. Moreover, no significant differences were found regarding complication rates between cohorts (7.3% AI vs. 4.8% IO; p = 0.86).

Conclusion

The present study underscores comparable clinical success between AI and IO meniscal repair techniques, with both techniques demonstrating similar complication rates. However, the AI repair technique was associated with 1.77 times higher odds of failure compared to the IO cohort.

Level of Evidence

Level III.

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半月板全内侧和全外侧修复术后的失败率和并发症发生率：系统回顾和荟萃分析。

目的：本研究探讨了半月板全内侧（AI）和全外侧（IO）修复技术的失败率、并发症发生率和患者报告结果指标（PROMs）：在PubMed、Embase和Cochrane上进行了系统性检索（起始时间至2024年1月），评估评估半月板修复术后效果的I-III级研究。主要结果是AI和IO修复技术失败率的差异。次要结果包括并发症发生率和PROMs的比较。质量评估采用建议分级评估、发展和评价以及非随机研究方法指数标准进行。对三项以上比较研究报告的结果进行了荟萃分析：共纳入了 24 项研究（13 项研究和 912 个人工关节半月板，17 项研究和 1,117 个人工关节半月板）。平均随访时间范围为 22-192 个月（AI）和 18.5-155 个月（IO）。据报道，AI组的总体失败率为5%至35%，而IO组为0%至25%。在比较同时进行前交叉韧带重建的半月板修复失败率时，AI 组的失败率为（AI：5%-34%；IO：0%-12.9%）。AI组的并发症发生率为0%-40%，IO组为0%-20.5%。IKDC术后PROM评分为81.2-93.8分（AI）对89.6-94分（IO），Tegner评分为4.0-7.02分（AI）对4.0-8.0分（IO）。将六项对比研究汇总后发现，IO 技术的失败率明显较低（AI 15.9% 对 IO 11.1%；P = 0.02），但这一结果受到一项主要针对精英运动员的研究的影响。此外，不同组别之间的并发症发生率也无明显差异（7.3% AI 对 4.8% IO；p = 0.86）：本研究强调了AI和IO半月板修复技术的临床成功率相当，两种技术的并发症发生率相似。然而，与IO队列相比，AI修复技术的失败几率要高出1.77倍：证据等级：三级。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).