Arthroscopic partial meniscectomy for meniscal tears of the knee: a systematic review and meta-analysis

Abstract

ObjectiveTo assess the benefit of arthroscopic partial meniscectomy (APM) in adults with a meniscal tear and knee pain in three defined populations (taking account of the comparison intervention): (A) all patients (any type of meniscal tear with or without radiographic osteoarthritis); (B) patients with any type of meniscal tear in a non-osteoarthritic knee; and (C) patients with an unstable meniscal tear in a non-osteoarthritic knee.DesignSystematic review and meta-analysis.DatasourcesA search of MEDLINE, Embase, CENTRAL, Scopus, Web of Science, Clinicaltrials.gov and ISRCTN was performed, unlimited by language or publication date (inception to 18 October 2018).EligibilitycriteriaRandomised controlled trials performed in adults with meniscal tears, comparing APM versus (1) non-surgical intervention; (2) pharmacological intervention; (3) surgical intervention; and (4) no intervention.ResultsTen trials were identified: seven compared with non-surgery, one pharmacological and two surgical. Findings were limited by small sample size, small number of trials and cross-over of participants to APM from comparator interventions. In group A (all patients) receiving APM versus non-surgical intervention (physiotherapy), at 6–12 months, there was a small mean improvement in knee pain (standardised mean difference [SMD] 0.22 [95% CI 0.03 to 0.40]; five trials, 943 patients; I2 48%; Grading of Recommendations Assessment, Development and Evaluation [GRADE]: low), knee-specific quality of life (SMD 0.43 [95% CI 0.10 to 0.75]; three trials, 350 patients; I2 56%; GRADE: low) and knee function (SMD 0.18 [95% CI 0.04 to 0.33]; six trials, 1050 patients; I2 27%; GRADE: low). When the analysis was restricted to people without osteoarthritis (group B), there was a small to moderate improvement in knee pain (SMD 0.35 [95% CI 0.04 to 0.66]; three trials, 402 patients; I2 58%; GRADE: very low), knee-specific quality of life (SMD 0.59 [95% CI 0.11 to 1.07]; two trials, 244 patients; I2 71%; GRADE: low) and knee function (SMD 0.30 [95% CI 0.06 to 0.53]; four trials, 507 patients; I2 44%; GRADE: very low). There was no improvement in knee pain, function or quality of life in patients receiving APM compared with placebo surgery at 6–12 months in group A or B (pain: SMD 0.08 [95% CI −0.24 to 0.41]; one trial, 146 patients; GRADE: low; function: SMD −0.08 [95% CI −0.41 to 0.24]; one trial, 146 patients; GRADE: high; quality of life: SMD 0.05 [95% CI −0.27 to 0.38]; one trial; 146 patients; GRADE: high). No trials were identified for people in group C.ConclusionPerforming APM in all patients with knee pain and a meniscal tear is not appropriate, and surgical treatment should not be considered the first-line intervention. There may, however, be a small-to-moderate benefit from APM compared with physiotherapy for patients without osteoarthritis. No trial has been limited to patients failing non-operative treatment or patients with an unstable meniscal tear in a non-arthritic joint; research is needed to establish the value of APM in this population.Protocol registration numberPROSPERO CRD42017056844.

Rates of knee arthroplasty within one-year of undergoing arthroscopic partial meniscectomy in England: temporal trends, regional and age-group variation in conversion rates

“…[15] A partial decline in the rate of APM being performed has been observed since 2013 and this seems to have been driven by the publication of high-level evidence. [14] The recent decline in intervention rate was seemingly broadly correlated with a slight decline in the rate of subsequent arthroplasty in our study. [15] The proportion of arthroplasty conversions remains considerably higher, however, than prior to the rapid increase in the rate of APM observed since 2001.…”

“…[5][6][7][8][9][10][11][12][13] These trials had a number of limitations but the findings broadly suggest that APM is less effective in patients with osteoarthritis in comparison to those without osteoarthritis. [14] In response to the publication of this high-level evidence and guidelines, a change in treatment selection would be anticipated and, indeed, there has been some decline in the rate of APM since 2013 in England, although APM is still one of the most commonly performed types of orthopaedic surgery, worldwide. [15][16][17] In England, APM surgery was most commonly performed in the 40-59-year and 60-79-year age groups in 2016-17 and the rate of intervention in these age groups increased considerably over the preceding 20-years.…”

Comparison of Arthroscopic Partial Meniscectomy to Physical Therapy following Degenerative Meniscus Tears: A Systematic Review and Meta-analysis

“…There have been a number of articles comparing APM with conservative treatment that did not pay close attention to the various follow-up time points and had a relatively short follow-up time period [33,34]. A study by Van de Graaf et al [35] concluded that there were differences after treatment between the two groups at 3 months and 6 months, but not at 12 months.…”

Meniscal tear outcome Study (METRO Study): a study protocol for a multicentre prospective cohort study exploring the factors which affect outcomes in patients with a meniscal tear

“…1 2 Over recent years, there has been a substantial increase in meniscus-related literature, with a number studies questioning the effectiveness of surgical management. [3][4][5] The meniscus is a highly specialised c-shaped structure located within the knee. 6 It has an important role in distributing load across the knee joint, preventing damage to the articular cartilage.…”