Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews

Abstract

Background Arthroscopic partial meniscectomy (APM) is widely applied for the treatment of degenerative meniscal lesions in middle-aged patients; however, such injury is often associated with mild or moderate osteoarthritis and has been reported by MRI in asymptomatic knees. Previous studies suggested, in most patients, a lack of benefit of surgical approach over conservative treatment, yet many controversies remain in clinical practice. Our aims were to assess the functional and pain scores between exercise therapy and arthroscopic surgery for degenerative meniscal lesions and to evaluate the methodological quality of the most recent systematic reviews (SRs). Methods Two authors independently searched PubMed and Google Scholar for SRs comparing the outcome (in knee pain and functionality) of arthroscopic treatment and exercise therapy or placebo for degenerative meniscal lesions. The timeframe set was from 2009 to 2019 included. Results A total of 13 SRs were selected. Two reviewers independently assessed the methodological quality of each paper using the AMSTAR 2 tool: seven scored as “moderate,” four obtained a “low” grade while the remaining two were evaluated as “critically low.” SRs agreed that in middle-aged patients with degenerative meniscal lesions arthroscopic surgery appears to grant no long-term improvement in pain and function over exercise therapy or placebo. Conclusions Conservative treatment based on physical therapy should be the first-line management. However, most SRs revealed subgroups of patients that fail to improve after conservative treatment and find relief when undergoing surgery. In the future, randomized controlled trials, evidence should be looked for that APM can be successful in case of the unsatisfactory results after physical therapy.

The Proportion of Meniscus Tears Considered Repairable, and Thus Repaired, Increased During a Single Surgeon’s Practice of 20 Years

“…APM on DMTs has shown not to improve outcomes from conservative treatment, 17 or from sham surgery, 18 , 19 so it has been proposed that it should not be performed as a first-line treatment, but only after failure of nonsurgical procedures. 17 , 20 Subsequently, the goal when treating DMTs should be to decrease the incidence of surgical treatment and, furthermore, taking into account that DMTs are less likely to be repaired because of their lower healing potential and the technical complexity.…”

“…APM on DMTs has shown not to improve outcomes from conservative treatment, 17 or from sham surgery, 18 , 19 so it has been proposed that it should not be performed as a first-line treatment, but only after failure of nonsurgical procedures. 17 , 20 Subsequently, the goal when treating DMTs should be to decrease the incidence of surgical treatment and, furthermore, taking into account that DMTs are less likely to be repaired because of their lower healing potential and the technical complexity. Such change could be seen in the present study and since 2002 to 2006, but it has increased in the past 10 years, enhanced by the emerging works 19 , 20 , 21 that provided scientific evidence that guides physicians and patients to treat degenerative tears nonoperatively.…”

Highlighting the Advantages and Benefits of Non-NSAID Treatment After Total Knee Arthroplasty: A Cross-sectional Study

“…Therefore, pain primarily originates from changes occurring in non-cartilaginous joint structures such as the ligaments, subchondral bone, joint capsule, periarticular muscles, and synovium (19,20). As the disease progresses, these structures are also affected, leading to noticeable changes such as weakening of periarticular muscles, bone remodeling, excessive accumulation of synovial fluid, ligament weakening, and osteophyte formation (21).…”