失败率随时间增加，且内侧关节镜桶柄状半月板修复术后失败率更高：系统综述与荟萃分析
简介
这篇meta分析汇总了2005年以来的关节镜下桶柄状半月板修复研究，发现总失败率为21.5%，且随随访时间延长而升高。内侧修复的失败风险显著高于外侧（18.9% vs. 12.1%），而撕裂区域及是否合并ACL重建对失败率无明显影响。提示内侧桶柄状修复术后失败风险更高，应重视术前告知与长期随访。
英文摘要
PURPOSE: Bucket-handle meniscal tears (BHMTs) constitute a technically demanding form of meniscal injury. However, the incidence of repair failure and the factors influencing outcomes remain incompletely characterised. This study aimed to estimate the pooled failure rate after bucket-handle meniscal repair (BHMR) and to identify variables associated with unsuccessful healing. METHODS: A systematic review and meta-analysis (SRMA) was performed to identify studies published from January 2005 through 2026 evaluating arthroscopic BHMR. Eligible designs included randomised trials, cohort studies and case series with at least 15 patients. Random-effects or fixed models were used to calculate pooled failure proportions and odds ratios. Subgroup analyses and meta-regression were conducted to explore potential predictors of failure. RESULTS: The pooled BHMR failure rate was 21.5% (95% CI: 16.3%-27.8%; I 2 = 79.2%). Failure rates increased with longer follow-up (β = 0.12, p < 0.01). Medial repairs had significantly higher failure odds than lateral repairs (OR = 2.20, p < 0.001, pooled failure rate: 18.9% vs. 12.1%). No significant differences were observed for tear zone (red-red vs. white-red), sex or isolated (pooled rate: 24.3%) versus concomitant ACLR (pooled rate: 14.9%). Publication bias was suggested by Egger's test (p = 0.02). CONCLUSION: BHMRs carry a substantial 21.5% failure rate that increases over time, with medial tears at significantly higher risk than lateral tears. Concomitant ACL reconstruction and tear vascularity did not significantly impact failure odds. High-quality prospective studies are needed to optimise patient selection and long-term counselling. LEVEL OF EVIDENCE: Level II.