高水平运动员前交叉韧带重建时半月板病变的处理：系统综述
简介
这项系统综述纳入5项研究、519例接受ACL重建并同期处理半月板病变的职业运动员（女性18%，加权平均年龄23.7岁），半月板损伤报告率为59%–86%，纵行后角撕裂最常见，ramp lesion和外侧后根撕裂也较常见。处理以保留半月板为主，多数可修复撕裂行修复；但内侧半月板撕裂的失败率和二次半月板切除率高于外侧，尤其采用all-inside技术修复时，而i…
英文摘要
BACKGROUND: Meniscal pathology is a frequent and clinically important finding at the time of anterior cruciate ligament (ACL) reconstruction, particularly in performance athletes who place high demands on knee stability, load tolerance, and return-to-sport expectations. While meniscal management in the general ACL population has been widely studied, athlete-specific literature is limited. This review evaluates the incidence, tear patterns, treatment strategies, and outcomes of meniscal pathology in professional athletes undergoing ACL reconstruction. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a search of PubMed was conducted from inception to September 2025. Studies including professional athletes older than 18 years old who underwent ACL reconstruction with detailed management of concomitant meniscus tears were included. Data on incidence, tear patterns, treatment strategies, and outcomes were extracted. Study quality was assessed using the Methodological Index for Non-randomized Studies (MINORS). RESULTS: Five studies including 519 patients (18% female) with a weighted mean age of 23.7 years were included. Four studies reported outcomes at minimum 1 year follow-up. Across cohorts, meniscal injuries were highly prevalent, with reported rates ranging from 59% to 86%. Longitudinal posterior horn tears were the most common tear morphology, while ramp lesions and lateral posterior root tears were also frequently identified. Meniscal preservation was strongly favored, with repair performed in most reparable tears. Medial meniscal tears demonstrated higher failure and secondary meniscectomy rates than lateral tears, especially when repaired with all-inside techniques, whereas inside-out and suture-hook techniques appeared more favorable for medial-sided pathology. Sport-specific differences were noted, with soccer players demonstrating more medial and posterior root pathology and skiers exhibiting relatively more complex and lateral-sided lesions. Despite variability in rehabilitation protocols, meniscal repair did not appear to compromise return-to-sport and may support longer athletic career longevity compared with meniscectomy. CONCLUSIONS: Current evidence supports a preservation-first strategy for meniscus tears during ACL reconstruction in performance athletes. Meniscectomy should be reserved for irreparable or nonfunctional tissue. Although available data are limited by retrospective designs and heterogeneity, meniscal preservation at the time of ACL reconstruction appears to optimize both return-to-play potential and long-term joint health in this high-demand population.