Surgical Interventions for the Treatment of Traumatic Vertical Longitudinal Meniscal Tears in Adults: A Systematic Review.

This project is a systematic review protocol developed to evaluate the effectiveness and safety of surgical interventions for the treatment of traumatic vertical longitudinal meniscal tears of the knee in adults. The review focuses on a clinically important subgroup of meniscal injuries, including bucket-handle tears, in which treatment decisions often involve choosing between tissue-preserving strategies and resection procedures. Meniscal tears are a common source of knee pain, mechanical symptoms, functional limitation, and time away from work, sports, and usual activities. In traumatic tears, particularly in younger or physically active individuals, surgical management is frequently considered. However, important uncertainties remain regarding which surgical approach provides the best balance between symptom relief, functional recovery, preservation of meniscal tissue, risk of failure or reoperation, and safety. In addition, the available literature is heterogeneous with respect to patient characteristics, tear morphology, surgical techniques, comparators, outcome definitions, and follow-up duration, which makes interpretation difficult and limits direct clinical conclusions. The main purpose of this review is to synthesize the best available evidence from randomized controlled trials comparing different surgical strategies for traumatic vertical longitudinal meniscal tears. Eligible interventions include partial, subtotal, or total meniscectomy; meniscal repair techniques such as all-inside, inside-out, outside-in, and hybrid approaches; meniscal transplantation; meniscal implants or scaffolds; and, when available, comparisons between surgical treatment and conservative management. The target population includes individuals aged 15 to 65 years with traumatic vertical longitudinal meniscal tears diagnosed by magnetic resonance imaging or arthroscopy and considered eligible for surgical treatment. The primary outcomes of interest are knee pain, self-reported knee function, and procedure-related failure, including reoperation or clinically defined treatment failure. Secondary outcomes include health-related quality of life, subjective knee instability, return to activity or sport, adverse events, and treatment costs. The review will include comprehensive searches in major bibliographic databases and clinical trial registries, with no restriction on language or year of publication. Study selection, data extraction, and risk of bias assessment will be performed independently by reviewers using prespecified methods. Risk of bias will be assessed with the Cochrane Risk of Bias 2 tool, and the certainty of the evidence will be evaluated using the GRADE approach. The expected outcome of this project is a transparent and methodologically rigorous synthesis of the comparative effectiveness and safety of surgical interventions for this specific type of meniscal tear. The review is expected to identify which interventions are supported by stronger evidence, clarify the degree of uncertainty surrounding current surgical choices, and highlight important evidence gaps for future research. Ultimately, the project aims to support evidence-informed clinical decision-making and improve the methodological and clinical understanding of treatment options for traumatic vertical longitudinal meniscal tears in adults.