Validity and generalizability of findings of randomized controlled trials on arthroscopic partial meniscectomy of the knee

Malmivaara, Antti

doi:10.1111/sms.13215

Cited by 12 publications

(16 citation statements)

References 31 publications

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“…43,68,73 Substantial evidence is available demonstrating no difference in clinical outcomes for APM versus conservative management for degenerative meniscal tears 1,70,77,78,106,132 ; however, the available evidence may be biased and of low quality. 58,87 Clinical outcomes tended to improve after APM and reoperation rates were low, although knee osteoarthritis is likely to develop after APM. 13,102,104 Meniscal repairs have been associated with good clinical outcomes overall, 45,81,143 and for isolated meniscal repairs there has been no difference in clinical outcomes between all-inside versus inside-out repairs.…”

Section: Discussionmentioning

confidence: 99%

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses

Smoak

Matthews

Vinod

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: A large number of systematic reviews and meta-analyses regarding the meniscus have been published. Purpose: To provide a qualitative summary of the published systematic reviews and meta-analyses regarding the meniscus. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of all meta-analyses and systematic reviews regarding the meniscus and published between July 2009 and July 2019 was performed with PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts, narrative reviews, articles not written in English, commentaries, study protocols, and topics that were not focused on the meniscus were excluded. The most pertinent results were extracted and summarized from each study. Results: A total of 332 articles were found, of which 142 were included. Included articles were summarized and divided into 16 topics: epidemiology, diagnosis, histology, biomechanics, comorbid pathology, animal models, arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root repairs, meniscal allograft transplantation (MAT), meniscal implants and scaffolds, mesenchymal stem cells and growth factors, postoperative rehabilitation, postoperative imaging assessment, patient-reported outcome measures, and cost-effectiveness. The majority of articles focused on APM (20%), MAT (18%), and meniscal repair (17%). Conclusion: This summary of systematic reviews and meta-analyses delivers surgeons a single source of the current evidence regarding the meniscus.

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Section: Discussionmentioning

confidence: 99%

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses

Smoak

Matthews

Vinod

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…The present study was the only RCT with comprehensive recruitment from a catchment area, which provided adequate representation of the population 33 and demonstrated a statistically and clinically significant positive effect of knee arthroscopic surgery with an exercise program after 1 year compared with an exercise program alone. 15 The objectives of the present study were to (1) evaluate whether knee arthroscopic surgery combined with an exercise program provided an additional 5-year benefit compared with an exercise program alone in middle-aged patients with meniscal symptoms, (2) determine whether baseline mechanical symptoms affected the outcome, and (3) compare radiographic changes between treatment groups.…”

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confidence: 86%

“…5,52,54 Nevertheless, the role of arthroscopic surgery in the treatment of degenerative meniscal tears remains controversial. 2,30,33 A recent review concluded that these patients could benefit from arthroscopic meniscectomy but that nonsurgical treatment should be considered first. 29 Mechanical symptoms were previously considered an indication for surgery; however, recent data have contradicted this tenet.…”

mentioning

confidence: 99%

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

Sonesson

Kvist

Yakob

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Arthroscopic meniscal surgery is a common orthopaedic procedure in middle-aged patients, but the efficacy of this procedure has been questioned. In this study, we followed up the only randomized controlled trial that has shown a 1-year benefit from knee arthroscopic surgery with an exercise program compared with an exercise program alone. Purpose: To (1) evaluate whether knee arthroscopic surgery combined with an exercise program provided an additional 5-year benefit compared with an exercise program alone in middle-aged patients with meniscal symptoms, (2) determine whether baseline mechanical symptoms affected the outcome, and (3) compare radiographic changes between treatment groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to either a 3-month exercise program (nonsurgery group) or to the same exercise program plus knee arthroscopic surgery (surgery group) within 4 weeks. Radiographs were assessed, according to the Kellgren-Lawrence grade, at baseline and at the 5-year follow-up. The primary outcome was the change in Knee injury and Osteoarthritis Outcome Score (KOOS)–Pain (KOOSPAIN) subscore from baseline to the 5-year follow-up. We performed an as-treated analysis. Results: A total of 102 patients completed the 5-year questionnaire. At the 5-year follow-up, both groups had significant improvement in KOOSPAIN subscores, although there was no significant change from the 3-year scores. There was no between-group difference in the change in the KOOSPAIN subscore from baseline to 5 years (3.2 points [95% CI, –6.1 to 12.4]; adjusted P = .403). In the surgery group, improvement was greater in patients without mechanical symptoms than in those with mechanical symptoms (mean difference, 18.4 points [95% CI, 8.7 to 28.1]; P < .001). Radiographic deterioration occurred in 60% of patients in the surgery group and 37% of those in the nonsurgery group ( P = .060). Conclusion: Knee arthroscopic surgery combined with an exercise program provided no additional long-term benefit after 5 years compared with the exercise program alone in middle-aged patients with meniscal symptoms. Surgical outcomes were better in patients without mechanical symptoms than in patients with mechanical symptoms during the preoperative period. Radiographic changes did not differ between treatment groups. Registration: NCT01288768 ( ClinicalTrials.gov identifier).

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“…Baseline comparability (the aim of randomization), description of adherence to interventions (a causal factor), and the validity of the outcome (effect) was assessed in 7%, 7% and 5% of the SRs, respectively. As these vital validity factors of an RCT are lacking, the appraisal of internal validity of individual RCTs is seriously impaired (24,25).…”

Section: Discussionmentioning

confidence: 99%

Generalizability of findings from systematic reviews and meta-analyses in the Leading General Medical Journals

Malmivaara¹

2020

J Rehabil Med

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In a systematic review it is important that all characteristics of randomized controlled trials are reported, so that clinicians can determine to which patients the results of a systematic review can be applied. This study assessed how comprehensively these characteristics of randomized controlled trials were recorded in the systematic reviews published in leading general medical journals. A search of the literature found a total of 115 systematic reviews. Of these, 71% were on pharmacological interventions, 35% were on other conservative treatments, 13% were on surgical interventions, and 0% were on rehabilitation interventions. None of the systematic reviews assessed how patients were selected to the study; 35% reported relevant clinical features; 25% comorbid conditions; and 21% patients' behavioural factors. Functioning, environmental factors, inequity-related factors; how interventions were carried out; how well the patients were followed-up; and the adequacy of statistical analyses were reported in only 0-9% of the systematic reviews. In conclusion, the reporting of study characteristics in the systematic reviews does not make it possible to assess how similar the different studies had been, or to which patients these study findings could be generalized. In future, randomized controlled trials should be described better in systematic reviews. Further studies are needed on this subject. Objective: To assess how items relevant for the assessment of the generalizability of findings from randomized controlled trials were recorded in systematic reviews published in leading general medical journals. Methods: All systematic reviews and meta-analyses published in the Annals of Internal Medicine, BMJ, JAMA (The Journal of the American Medical Association) and Lancet from 1 January 2016 to 28 February 2019 were searched via PubMed. Reporting of the characteristics of randomized controlled trials in the systematic reviews was documented by the benchmarking method. Results: A total of 115 systematic reviews were found. Of these, 71% included pharmacological interventions, 35% included other conservative treatments, 13% included surgical interventions, and 0% included rehabilitation interventions. None of the systematic reviews assessed patient selection, 35% reported disorder-specific clinical features, 25 % reported comorbid conditions, and 21% reported patients' behavioural factors in randomized controlled trials. Functioning, environmental factors and inequity-related factors were recorded in 3%, 0% and 9%, respectively, of the systematic reviews; and adherence to interventions, crossovers, and co-interventions in 7%, 0% and 2%, respectively; followup percentages in 8%; and adequacy of statistical analyses in 3%. Conclusion: In all systematic reviews the recording of characteristics of patients, adherence to interventions, follow-up, and statistical analyses in the RCTs was insufficient. The data did not allow assessment of the clinical homogeneity of the randomized controlled trials, or provide justification for me...

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Validity and generalizability of findings of randomized controlled trials on arthroscopic partial meniscectomy of the knee

Cited by 12 publications

References 31 publications

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

Generalizability of findings from systematic reviews and meta-analyses in the Leading General Medical Journals

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