Home-Based vs Supervised Inpatient and/or Outpatient Rehabilitation Following Knee Meniscectomy: A Systematic Review and Meta-analysis

Abstract

Importance: Arthroscopic meniscectomy is one of the most common orthopedic procedures. The optimal postoperative approach remains debated.

Objective: To compare outcomes associated with home-based rehabilitation programs (HBP) vs standard inpatient and/or outpatient supervised physical therapy (IOP) following arthroscopic isolated meniscectomy (AM).

Data sources: A systematic literature search was conducted on PubMed, Web of Science, Cochrane Library, and Scopus databases on March 15, 2021. The included studies were published from 1982 to 2019.

Study selection: Randomized clinical trials of patients treated with HBP vs IOP after AM were included.

Data extraction and synthesis: Data were independently screened and extracted by 2 authors according to the Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guideline. The meta-analysis was performed using a random-effect model; when an I2 < 25% was observed, the fixed-effect model was used. The Hartung-Knapp correction was applied.

Main outcomes and measures: The primary outcome was the Lysholm score (scale of 0-100 with higher scores indicating better knee function) and secondary outcomes were subjective International Knee Documentation Committee (IKDC) score, knee extension and flexion, thigh girth, horizontal and vertical hop test, and days to return to work, as indicated in the PROSPERO registration. Outcomes were measured in the short-term (ranging from 28 to 50 days) and the midterm (6 months).

Results: In this meta-analysis of 8 RCTs including 434 patients, IOP was associated with a greater short-term improvement in Lysholm score compared with HBP, with a mean difference of -8.64 points (95% CI, -15.14 to -2.13 points; P = .02) between the 2 approached, but the sensitivity analysis showed no difference. Similarly, no statistically significant difference was detected at midterm for Lysholm score, with a mean difference between groups of -4.78 points (95% CI, -9.98 to 0.42 points; P = .07). HBP was associated with a greater short-term improvement in thigh girth, with a mean difference between groups of 1.38 cm (95% CI, 0.27 to 2.48 cm; P = .01), whereas IOP was associated with a better short-term vertical hop score, with a mean difference between groups of -3.25 cm (95% CI, -6.20 to -0.29 cm; P = .03). No differences were found for all the other secondary outcomes.

Conclusions and relevance: No intervention was found to be superior in terms of physical and functional outcomes as well as work-related and patient-reported outcomes, both at short-term and midterm follow-up. Overall, these results suggest that HBP may be an effective management approach after AM in the general population.

Figure 1.. Flowchart of the Study Selection Process

PT indicates physical therapy.

Figure 2.. Forest Plots of the Patient-Reported Outcomes

The outcomes of home-based rehabilitation (experimental group) are compared with inpatient and/or outpatient rehabilitation (control group) and the performed sensitivity analysis. Lysholm scores and IKDC scores range from 0 to 100 with higher scores indicating better knee function and fewer symptoms. Values for mean, SD, and MD Lysholm and IKDC scores are given as points. HBP indicates home-based rehabilitation; IKDC, subjective International Knee Documentation Committee score; IOP, inpatient and/or outpatient rehabilitation; MD, mean difference.

Figure 3.. Forest Plots of the Physical Outcomes

The outcomes of home-based rehabilitation (experimental group) are compared with inpatient and/or outpatient rehabilitation (control group). Values for mean, SD, and MD knee flexion and knee extension are given as degrees. Values for mean, SD, and MD thigh girth are given as centimeters. HBP indicates home-based rehabilitation; IOP, inpatient and/or outpatient rehabilitation; MD, mean difference.

Figure 4.. Forest Plots of the Functional and Work-Related Outcomes

The outcomes of home-based rehabilitation (experimental group) are compared with inpatient and/or outpatient rehabilitation (control group). Values for mean, SD, and MD single hop and vertical hop tests are given as centimeters. Values for total, mean, and SD return to work are given as days. HBP indicates home-based rehabilitation; IOP, inpatient and/or outpatient rehabilitation; MD, mean difference.