Bioabsorbable arrows versus screws in meniscal repair .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(2):203 Am J Sports Med. 2010 Nov;38(11):2211-7.42 patients undergoing all-inside meniscal repair were randomized to be treated with bioabsorbable meniscal arrows or meniscal screws, with the hypothesis that similar clinical outcomes would be seen at short-term follow-up for meniscal repair. At an average follow-up time of 27 months, the clinical outcomes, measured Lysholm score and the International Knee Documentation Committee (IKDC) knee score, were similar, except the arrow group showed significantly greater chondral damage.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
The recommended treatment for meniscal tears is to repair the tear and to save the menisci whenever possible. The focus now has shifted towards all-inside meniscal repair techniques.At present, there is a lack of prospective randomized clinical studies that compare these different all-inside meniscal repair devices. In a 2 year study period, this trial compared 2 such techniques: repair with the bioabsorbable Trinion meniscal screw and repair with the bioabsorbable meniscus arrow.
¿Cuál era la pregunta principal de la investigación?
Are there any differences in clinical and radiographic outcomes of an all inside meniscal repair with the use of bioabsorbable meniscal screw and bioabsorbable meniscal arrow 2 years after surgery?
- The Lysholm score, the IKDC function score, and the IKDC final score reported no significant difference between the groups preoperatively and at the 2-year follow-up.
- In the meniscal arrow group, mild chondral damage (grade I) was observed in 5 patients in the medial femoral condyle on the same side as the meniscal repair, while In the screw group, no chondral damage was observed (p = 0.008).
- 17% of the screw group and 30% in the arrow group had failures (P = 0.242)
- The meniscal healed in 14 patients (8 in the screw group and 6 in the arrow group), and as partially healed in 4 patients (3 in the screw group and 1 in the arrow group).
- No significant differences were seen in tenderness in the joint line by McMurray test at 2 year follow up.
- All knees were stable and similar proportion of patients were able to carry out same level sporting activity (15 vs 12) or at a lower level activity (2 in each group)
¿Qué es lo que más debo recordar?
All-inside meniscal repair with bio-absorbable meniscal screws and arrows resulted in similar clinical outcomes. However, significantly more chondral damage was observed when patients received arrows for fixation. The authors discontinued the study for ethical reasons based on the observed chondral damage findings.
¿Cómo afectará esto al cuidado de mis pacientes?
According to the study findings, it was suggested that meniscal repair performed with bioabsorbable meniscal screws resulted in better results than the meniscal repair with bioabsorbable meniscus arrows. The use of meniscal arrows for fixation was associated with significant chondral damage.
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