Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review
Romina Brignardello-Petersen,Romina Brignardello-Petersen,Gordon H. Guyatt,Rachelle Buchbinder,Rudolf W. Poolman,Stefan Schandelmaier,Stefan Schandelmaier,Yaping Chang,Behnam Sadeghirad,Behnam Sadeghirad,Nathan Evaniew,Per Olav Vandvik +11 more
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TLDR
Over the long term, patients who undergo knee arthroscopy versus those who receive conservative management strategies do not have important benefits in pain or function.Abstract:
Objective To determine the effects and complications of arthroscopic surgery compared with conservative management strategies in patients with degenerative knee disease. Design Systematic review. Main outcome measures Pain, function, adverse events. Data sources MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and Open Grey up to August 2016. Eligibility criteria For 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 methods Two 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. Results We 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. Conclusions Over 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 number PROSPERO CRD42016046242.read more
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Arthroscopic surgery for degenerative knee arthritis and meniscal tears: A clinical practice guideline
Reed A C Siemieniuk,Reed A C Siemieniuk,Ian A. Harris,Thomas Agoritsas,Rudolf W. Poolman,Romina Brignardello-Petersen,Romina Brignardello-Petersen,Stijn Van de Velde,Rachelle Buchbinder,Martin Englund,Lyubov Lytvyn,Casey Quinlan,Lise Mørkved Helsingen,Gunnar Knutsen,Nina Rydland Olsen,Helen Macdonald,Louise Hailey,Hazel M. Wilson,Anne Lydiatt,Annette Kristiansen +19 more
TL;DR: An expert panel produced these recommendations based on a linked systematic review triggered by a randomised trial published in The BMJ in June 2016 which found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy.
Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear
Raine Sihvonen,Mika Paavola,Antti Malmivaara,Ari Itälä,Antti Joukainen,Heikki Nurmi,Juha Kalske,Teppo L. N. Järvinen +7 more
TL;DR: In this article, the authors conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis.
Journal ArticleDOI
Application of minimal important differences in degenerative knee disease outcomes: a systematic review and case study to inform BMJ Rapid Recommendations
Tahira Devji,Gordon H. Guyatt,Lyubov Lytvyn,Romina Brignardello-Petersen,Romina Brignardello-Petersen,Farid Foroutan,Farid Foroutan,Behnam Sadeghirad,Behnam Sadeghirad,Rachelle Buchbinder,Rudolf W. Poolman,Ian A. Harris,Alonso Carrasco-Labra,Alonso Carrasco-Labra,Reed A C Siemieniuk,Reed A C Siemieniuk,Per Olav Vandvik +16 more
TL;DR: The most credible anchor-based minimal important differences (MIDs) for patient important outcomes in patients with degenerative knee disease are identified to inform BMJ Rapid Recommendations for arthroscopic surgery versus conservative management Design Systematic review.
Journal ArticleDOI
Arthroscopic partial meniscectomy for meniscal tears of the knee: a systematic review and meta-analysis
TL;DR: Performing APM in all patients with knee pain and a meniscal tear is not appropriate, and surgical treatment should not be considered the first-line intervention; there may, however, be a small-to-moderate benefit from APM compared with physiotherapy for patients without osteoarthritis.
References
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