SPORTS MEDICINE
Suture Repair versus Arrow Repair for Symptomatic Meniscus Tears of the Knee: A Systematic Review
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(4):58 J Knee Surg. 2012 Nov;25(5):397-402. doi: 10.1055/s-0032-1313752. Epub 2012 May 15Exclusive Author Interview
This systematic review included 4 studies (2 randomized controlled trials and 2 comparative observational studies) that compared arrow repair and suture repair for patients with symptomatic meniscus tears of the knee. Results indicated that there was no difference between the two repair techniques for the mean retear and healing rate, knee rating scores, and time to re-operation. However, the quality of evidence included in this review was not optimal and firm conclusions regarding the effectiveness of arrow repair compared to suture repair can not be made.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Introduction
3/4
Accessing Data
3/4
Analysing Data
1/4
Results
2/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
If possible, it is crucial for a patient with a tear in the meniscus to receive repair, as removal of the meniscus is associated with the onset of detrimental changes, such as knee osteoarthritis. Suture repair, a technique in which the edges of the torn meniscus are sutured, has been considered the gold standard repair method for meniscus tears for some time. However, some surgeons now employ the newer arrow repair technique instead of suture repair, and it is currently uncertain as to which technique is most effective with regards to clinical outcomes. This systematic review, therefore, aimed to gather data from various trials in order to determine which meniscal repair technique is superior in patients with meniscus tears.
主な研究課題は何ですか？
Is arrow repair more effective than suture repair with regards to the rate of retear and healing in patients with meniscus tears of the knee?
重要な知見は？
- 1 randomized controlled trial (RCT) indicated that there was no difference between the two techniques for the rate of failure (p=0.92)
- According to another RCT, the two techniques did not differ with respect to the healing rate (p=0.11); at repeat arthroscopy, full or partial healing of the menisci was seen in 30 patients in the arrow group and 24 patients in the suture group
- Based on the Hospital for Special Surgery Knee Rating System used in one observational study, satisfactory results (excellent or good results) were found in 17 patients of the suture group and 22 patients of the arrow group (the study indicated that there was no clinical difference between the two groups)
- According to the second observational study, there was no difference between the two groups for the mean time to re-operation (p=0.85)
最も覚えておくべきことは？
There was no difference between the arrow and suture repair techniques with respect to healing and re-tear rates, knee rating scores, and mean time to re-operation.
それが私の患者ケアにどのように影響するか？
Firm conclusions regarding the optimal treatment for patients with meniscus tears of the knee can not be made due to the low quality of the studies used in this review. Further research with fewer methodological flaws and larger sample sizes are needed to compare arrow and suture repair in order to form definitive conclusions.
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