解决半月板缺损问题第一部分：半月板同种异体移植的系统回顾和荟萃分析总览

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-09-30 DOI:10.1002/jeo2.12107

Kevin A. Wu, Lulla V. Kiwinda, Aaron D. Therien, Christian J. Castillo, Stephanie Hendren, Jason S. Long, Annunziato Amendola, Brian C. Lau

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引用次数: 0

摘要

目的半月板损伤在活跃的年轻人群中很常见。在半月板损伤导致半月板缺损后，越来越多的人采用半月板同种异体移植（MAT）等外科干预措施来恢复半月板的保护功能。关于半月板损伤的治疗和半月板缺损的后遗症，已有大量的研究和出版物。然而，目前还缺乏通过总综述对现有证据进行全面总结的方法。本研究旨在通过对有关 MAT 的文献进行最新研究，填补这一空白。方法在 MEDLINE、Embase 和 Scopus 数据库中进行全面检索，以确定相关的系统综述和荟萃分析。根据预先确定的纳入和排除标准对研究进行筛选。采用 AMSTAR-2 工具对纳入研究的质量进行评估。结果本次综述共纳入 41 项研究，其中大部分研究发表于过去十年间。大部分研究（56.1%）的可信度被评为 "极低"，26.8%被评为 "低"，只有14.6%被评为 "高"。在纳入的研究中，51.2%报告了PROMs，其中最常见的是Lysholm评分。分别有 34.1% 和 19.5% 的研究报告了移植失败和再手术率。有关 MAT 的研究报告显示，患者报告的结果指标（PROMs）显示短期疗效良好，但由于缺乏随机对照试验和一致的比较组，研究结果有限。结论本综述强调了人们对 MAT 的兴趣日益浓厚，但同时也强调了需要通过标准化的报告和严格的方法进行更高质量的综述。未来的研究应侧重于长期结果、最佳手术技术、患者选择标准和移植失败的风险因素。此外，还需要开展更多关于儿科 MAT 的研究。总之，本综述对 MAT 的研究现状进行了全面评估，并指出了未来研究中需要改进的地方。证据等级 IV 级。

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Addressing meniscal deficiency part 1: An umbrella review of systematic reviews and meta-analyses on meniscal allograft transplantation

Purpose

Meniscal injuries are common in the young and active population. There is increasing utilization of surgical interventions like meniscal allograft transplantation (MAT) to restore the protective function of menisci following injury leading to meniscal deficiency. Extensive research and publications exist on the management of meniscal injury and the sequalae of meniscal deficiency. However, a comprehensive synthesis of the existing evidence through an umbrella review is lacking. This study aims to fill this gap by providing a current examination of the literature on MAT.

Methods

A comprehensive search was conducted in the MEDLINE, Embase and Scopus databases to identify relevant systematic reviews and meta-analyses. Studies were screened based on predefined inclusion and exclusion criteria. The quality of the included studies was assessed using the AMSTAR-2 tool.

Results

A total of 41 studies were included in the review, with most published within the last decade. The majority of studies (56.1%) received a ‘Critically Low’ confidence rating, 26.8% were rated as ‘Low’, and only 14.6% were rated as ‘High’ confidence. From the included studies, 51.2% reported on PROMs, with the Lysholm score being the most common. Transplant failure and reoperation rate were reported in 34.1% and 19.5% of studies respectively. Studies on MAT reported favourable short-term outcomes in terms of patient-reported outcome measures (PROMs) but were limited by the lack of randomized control trials and consistent comparison groups.

Conclusions

This umbrella review highlights an increase in interest in MAT but underscores the need for higher-quality reviews with standardized reporting and rigorous methodologies. Future research should focus on long-term outcomes, optimal surgical techniques, patient selection criteria and risk factors for transplant failure. There is also a need for more studies focusing on MAT in pediatric populations. Overall, this review provides a comprehensive assessment of the current state of research in MAT and identifies areas for improvement in future studies.