Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review

Abstract

ObjectiveTo determine the effects and complications of arthroscopic surgery compared with conservative management strategies in patients with degenerative knee disease.DesignSystematic review.Main outcome measuresPain, function, adverse events.Data sourcesMEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and Open Grey up to August 2016.Eligibility criteriaFor effects, randomised clinical trials (RCTs) comparing arthroscopic surgery with a conservative management strategy (including sham surgery) in patients with degenerative knee disease. For complications, RCTs and observational studies.Review methodsTwo reviewers independently extracted data and assessed risk of bias for patient-important outcomes. A parallel guideline committee (BMJ Rapid Recommendations) provided input on the design and interpretation of the systematic review, including selection of patient-important outcomes. We used the GRADE approach to rate the certainty (quality) of the evidence.ResultsWe included 13 RCTs and 12 observational studies. With respect to pain, the review identified high-certainty evidence that knee arthroscopy results in a very small reduction in pain up to 3 months (mean difference =5.4 on a 100-point scale, 95% CI 2.0 to 8.8) and very small or no pain reduction up to 2 years (mean difference =3.1, 95% CI −0.2 to 6.4) when compared with conservative management. With respect to function, the review identified moderate-certainty evidence that knee arthroscopy results in a very small improvement in the short term (mean difference =4.9 on a 100-point scale, 95% CI 1.5 to 8.4) and very small or no improved function up to 2 years (mean difference =3.2, 95% CI −0.5 to 6.8). Alternative presentations of magnitude of effect, and associated sensitivity analyses, were consistent with the findings of the primary analysis. Low-quality evidence suggested a very low probability of serious complications after knee arthroscopy.ConclusionsOver the long term, patients who undergo knee arthroscopy versus those who receive conservative management strategies do not have important benefits in pain or function.Trial registration numberPROSPERO CRD42016046242.

Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline

“…20 21 The systematic review on the net benefit of knee arthroscopy compared with non-operative care pools data from 13 randomised trials for benefit outcomes (1668 patients) and an additional 12 observational studies for complications (>1.8 million patients). 21 Figure 2 gives an overview of the patients included, the study funding, and patient involvement in the design of the studies.…”

Prevalence and healthcare usage of knee pain in South Australia: a population‐based study

“…The NWAHS data also showed that approximately 1/3 of participants who underwent knee arthroscopy also had a knee MRI performed. Clinical guidelines for investigation of knee pain do not support the routine use of arthroscopy, nor MRI and arthroscopy in combination to investigate subacute knee pain . Therefore, if even 1/3 of the 7888 knee arthroscopies performed in SA in 2015 were unnecessary procedures, at a cost to Medicare of $272–796 per procedure, excess costs incurred by unnecessary knee arthroscopies could conservatively exceed $715 000–$2 000 000 per year in SA.…”

“…A recent meta‐analysis of evidence for knee arthroscopy has prompted a strong recommendation against arthroscopy being performed in cases of chronic atraumatic knee pain . Trends in healthcare service usage for presentations of knee pain in SA, however, appear to indicate high rates of knee arthroscopy use.…”

The Role of Osteosynthesys Materials in the Etiopathology of Bone Malignant Tumors and Reconstruction Possibilities. Case report

“…Often times, the biomaterials used in orthopaedic surgery are neither ostheosynthesis matherials nor bone augments, but endoprothetics. These are used generally to replace worn-down joints, such as an uncemented or cemented knee prosthesis [16] for a patient whose ostheoarthrosis has progressed beyond conservative or arthroscopic treatment, [17][18][19][20] but a certain type of prosthesis, the reconstructive prosthesis, which are used to rebuild a joint and/or portion of bone that was removed during radical tumor surgery. Reconstructive surgery of the joints, especially of the hip or knee, if not planned out and executed with precision, may lead to modifications in the axis of movement of the limb, potentially leading, in time, to degenerative wear of the unaffected joints or alterations in the balance of the spine and pelvis or the plantar arches and plantar fasciitis [21].…”