Effectiveness of Meniscus Root Tear Repair Versus Conservative Therapy and Adjunct Therapies: A Systematic Review.

Abstract

The meniscus plays a vital role in knee biomechanics, particularly in load distribution and stability. Meniscus root tears (MRTs) compromise these functions, resulting in biomechanical alterations and knee osteoarthritis. The effectiveness of different MRT treatments is not yet well defined. This study aimed to compare the effectiveness of MRT repair versus conservative therapy and conservative therapy versus multimodal or adjunct therapy in patients with MRTs. A systematic review of clinical studies was performed using electronic searches of PubMed, CENTRAL, CINAHL, and PEDro databases. Two reviewers independently conducted screening, data extraction, risk of bias assessment, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The database search identified 3,837 articles, of which 11 (three randomized controlled trials [RCTs] and eight cohort studies) were relevant. MRT repair surgery and conservative treatment improved the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for activities of daily living (ADL) and quality of life (QOL). Multimodal or adjunct therapies also enhanced KOOS subscales for ADL and QOL. In the bias risk assessment, three RCTs were of high risk, five cohort studies were of high quality, and three were of moderate quality. Additionally, the certainty of evidence was very low for all comparisons in GRADE. Therefore, the effectiveness of MRT repair, conservative therapy, and multimodal therapy remains unclear owing to the risk of bias and low certainty of evidence. Whether MRT repair versus conservative therapy and conventional versus multimodal or adjunct therapy are more effective in improving ADL and QOL remains unclear. Future treatment decisions require long-term, high-quality research including controlled and randomized trials with large sample sizes.