Arthroscopic Partial Meniscectomy or Conservative Treatment for Nonobstructive Meniscal Tears: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Graaf, Victor A. van de; Wolterbeek, Nienke; Mutsaerts, Eduard L. A. R.; Scholtes, Vanessa A.; Saris, Daniël B.F.; Gast, Arthur de; Poolman, Rudolf W.

doi:10.1016/j.arthro.2016.05.036

Cited by 64 publications

(48 citation statements)

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“…24 Arthroscopic partial meniscectomy (APM) is still the most frequent orthopaedic procedure in orthopaedic surgery, although there is evidence that more conservative treatments should be preferred as the first-line treatment when not associated with an acute tear, such as with an ACL tear. [30][31][32][33] Indications for meniscus repair include symptoms directly attributable to the tear, reducibility of the tear, good tissue integrity, and favorable tear characteristics (e.g., single vertical) in one plane in the red-red (R-R) or red-white (R-W) zones of the meniscus or when an ACL is reconstructed. 15,29,34 The following tears are generally considered less amenable for repair: chronic tears with plastic deformity, complete tears with oblique, horizontal cleavage, or complex degenerative pattern in the W-W zone of the meniscus.…”

Section: Current Clinical Management Of Meniscus Tearsmentioning

confidence: 99%

Augmentation Techniques for Meniscus Repair

et al. 2017

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Menisci display exquisitely complex structure and play an essential weight-bearing role in the knee joint. A torn meniscus is one of the most common knee injuries which can result in pain and mechanical abnormalities. Tear location is one aspect which determines the endogenous healing response; tears that occur in the peripheral densely vascularized zone of the meniscus have the potential to heal while the healing capacity is more limited in the less vascularized inner zones. Meniscectomy was once widely performed, but led to poor radiographic and patient-reported mid- and long-term outcomes. After the advent of arthroscopy, orthopaedic opinion in the 1980s has been swaying toward salvaging or repairing the torn meniscus tissue to prevent osteoarthritis rather than performing meniscectomy. Meniscus repair in young active individuals has been shown to be effective, reproducible, and reliable if indications are met; however, only a small proportion of all tears are considered repairable with available technologies. Biological augmentation techniques and meniscus tissue engineering strategies are being devised to enhance the likelihood and rate of healing in meniscus repair. Preclinical and clinical studies have shown that introduction of cellular elements of the blood, bone marrow, and related growth factors have the potential to enhance meniscus repair. This article reviews the current state of clinical management of meniscus tears (primary repair) as well as augmentation techniques to improve healing by meniscus wrapping with extracellular matrix materials, trephination, synovial rasping and abrasion, fibrin/blood clot placement, and platelet-rich plasma injections. In addition, the rationale for using polymer/autologous blood component implants to improve meniscus repair will be discussed.

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Section: Current Clinical Management Of Meniscus Tearsmentioning

confidence: 99%

Augmentation Techniques for Meniscus Repair

et al. 2017

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“…In this study, both treatment choices yielded similar results in the long-term in terms of pain and physical functions. In a meta-analysis conducted by van de Graaf et al [22] including randomized-controlled studies comparing arthroscopic menisectomy and conservative treatment outcomes, surgical treatment was found to be superior to conservative treatment based on the KOOS scores. In this meta-analysis, there was no significant difference between the operation and conservative groups in terms of pain and physical functions according to the KOOS and scores at 12 and 24 months during follow-up.…”

Section: Discussionmentioning

confidence: 99%

The role of magnetic resonance imaging and clinical assessments in predicting meniscal tear surgery

Karakoç

Atalay

2019

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada menisküs yırtığı cerrahisini öngörmede fizik muayene ve manyetik rezonans görüntüleme (MRG) bulgularının rolü araştırıldı. Hastalar ve yöntemler: Ocak 2012-Mart 2018 tarihleri arasında menisküs yırtığı nedeniyle başka bir merkezde cerrahi önerilmiş, ancak takibine hastanemizde devam eden toplam 997 hastanın (563 kadın, 434 erkek; ort. yaş 40.53 yıl; dağılım, 18-66 yıl) tıbbi verileri retrospektif olarak incelendi. Demografik ve klinik özellikler, fizik muayene bulguları ve MRG sonuçları dahil olmak üzere hasta verileri kaydedildi. Görsel analog ölçeği (GAÖ) skorları ve Diz İncinme ve Osteoartrit Sonuç Skoru (KOOS) değerlendirildi. Bulgular: Manyetik rezonans görüntüleme ile değerlendirilen tüm hastalardan %62.4'üne özel hastanelerde cerrahi tedavi ve %37.6'sına devlet hastanelerinde cerrahi girişim önerildi. Bu hastaların yalnızca 282'si (%28.3) MRG değerlendirmesi ve fizik muayene sonrasında kliniğimizde menisküs yırtığı nedeniyle cerrahi olarak tedavi edildi. Tedavi öncesi medyan GAÖ skoru cerrahi yapılan grupta 7.0 (dağılım, 4-10) ve konservatif tedavi uygulanan grupta 6.0 (dağılım, 3-8) idi. Cerrahi sonrası altıncı ayda ve birinci yılda GAÖ ve KOOS skorları gruplar arasında benzerdi (sırasıyla p= 0.940, p= 0.203; p=116, p=0.057). Her iki grupta da tedavi sonrası ağrı skorları anlamlı düzeyde azalırken, KOOS skorları anlamlı düzeyde arttı (tümü için p= 0.001). Sonuç: Menisküs yırtıklarında cerrahi kararı, fizik muayene ve radyolojik bulgular ile birlikte verilmelidir.Anahtar sözcükler: Artroskopi, klinik değerlendirme, manyetik rezonans görüntüleme, menisküs yırtığı, cerrahi dışı tedavi. ABSTRACTObjectives: This study aims to investigate the role of physical examination and magnetic resonance imaging (MRI) findings in predicting meniscal tear surgery. Patients and methods: Medical records of a total of 997 patients (563 females, 434 males; mean age 40.53 years; range 18 to 66 years) who were recommended surgery for meniscal tear in an external center, but continued follow-up in our hospital between January 2012 and March 2018 were retrospectively analyzed. Data of the patients including demographic and clinical characteristics, physical examination findings, and MRI results were recorded. The visual analog scales (VAS) scores and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were evaluated. Results: Of all the patients evaluated by MRI, 62.4% were recommended surgical treatment in private hospitals and 37.6% were recommended surgical intervention in state hospitals. Only 282 of them (28.3%) were treated surgically for meniscal tear after MRI evaluation and physical examination in our clinic. The median pre-treatment VAS score was 7.0 (range, 4 to 10) and 6.0 (range, 3 to 8) in the patients undergoing surgery and undergoing conservative treatment, respectively. The VAS and KOOS scores were similar between the groups at the postoperative sixth month and first year (p= 0.940, p= 0.203; p=116, p= 0.057, respectively). Pain scores significantly decreased, while the KOOS scores signifi...

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“…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. In this paper, a new search was conducted to identify the latest literature, which allowed for the inclusion of a new multicenter RCT study.…”

Section: Discussionmentioning

confidence: 99%

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

Zhu

Gao

et al. 2020

BioMed Research International

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Objective. To compare the effectiveness of arthroscopic partial meniscectomy (APM) and physical therapy (PT) for degenerative meniscus tears. Method. We conducted a literature search through PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Randomized controlled trials in adults with degenerative meniscal tears without symptoms of locking were considered for inclusion. Two researchers independently performed the literature search, assessed the risk of bias, and selected eligible studies. The primary outcome was function at different follow-up time points and the secondary outcome was pain at different follow-up time points. Results. We included 6 randomized controlled trials, with a total of 1006 participants, among which 495 were in the APM group and 511 were in the PT group. We found a small benefit in functional outcomes in the APM group until the 12 months follow-up time point (SMD=0.20; 95%CI=0.0‐0.33; p=0.002; I2=34%), but no significant differences in function between groups at the 24-month follow-up time point (SMD=0.12; 95%CI=−0.04−0.28;p=0.14; I2=28%). There was also small benefit in the APM group until the 12 months follow-up time point for pain (SMD=0.14; 95%CI=0.01−027; p=0.03; I2=36%), but no significant difference in pain between groups at 24 months (SMD=0.11; 95%CI=−0.05−0.28; p=0.18; I2=0%). Conclusion. In the treatment of degenerative meniscus tears, APM yielded better functional and pain outcomes compared with physical therapy in the short term until 12 months, but there were comparable results for pain and functional outcomes between the groups at the 24 months follow-up time point.

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Arthroscopic Partial Meniscectomy or Conservative Treatment for Nonobstructive Meniscal Tears: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Cited by 64 publications

References 40 publications

Augmentation Techniques for Meniscus Repair

Augmentation Techniques for Meniscus Repair

The role of magnetic resonance imaging and clinical assessments in predicting meniscal tear surgery

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

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