Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis

Abstract

Background: Arthroscopic surgery for degenerative meniscal tears is a commonly performed procedure, yet the role of conservative treatment for these patients is unclear. This systematic review and meta-analysis evaluates the efficacy of arthroscopic meniscal débridement in patients with knee pain in the setting of mild or no concurrent osteoarthritis of the knee in comparison with nonoperative or sham treatments.

Methods: We searched MEDLINE, Embase and the Cochrane databases for randomized controlled trials (RCTs) published from 1946 to Jan. 20, 2014. Two reviewers independently screened all titles and abstracts for eligibility. We assessed risk of bias for all included studies and pooled outcomes using a random-effects model. Outcomes (i.e., function and pain relief) were dichotomized to short-term (< 6 mo) and long-term (< 2 yr) data.

Results: Seven RCTs (n = 805 patients) were included in this review. The pooled treatment effect of arthroscopic surgery did not show a significant or minimally important difference (MID) between treatment arms for long-term functional outcomes (standardized mean difference [SMD] 0.07, 95% confidence interval [CI] -0.10 to 0.23). Short-term functional outcomes between groups were significant but did not exceed the threshold for MID (SMD 0.25, 95% CI 0.02 to 0.48). Arthroscopic surgery did not result in a significant improvement in pain scores in the short term (mean difference [MD] 0.20, 95% CI -0.67 to 0.26) or in the long term (MD -0.06, 95% CI -0.28 to 0.15). Statistical heterogeneity was low to moderate for the outcomes.

Interpretation: There is moderate evidence to suggest that there is no benefit to arthroscopic meniscal débridement for degenerative meniscal tears in comparison with nonoperative or sham treatments in middle-aged patients with mild or no concomitant osteoarthritis. A trial of nonoperative management should be the first-line treatment for such patients.

Figure 1:

Selection of randomized controlled trials (RCTs) for inclusion in the meta-analysis.

Figure 2:

Risk-of-bias assessment of randomized controlled trials included in the meta-analysis.

Figure 3:

Pooled short-term functional outcomes of conservative and surgical treatment. Red lines show a zone of clinical equivalence based on a minimal important difference of 10 on the Knee Injury and Osteoarthritis Outcome Score.,,– Note: CI = confidence interval, SD = standard deviation, SMD = standardized mean difference.

Figure 4:

Pooled long-term functional outcomes of conservative and surgical treatment. Red lines show a zone of clinical equivalence based on a minimal important difference of 10 on the Knee Injury and Osteoarthritis Outcome Score.–, Note: CI = confidence interval, SD = standard deviation, SMD = standardized mean difference.