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

A systematic review and meta-analysis of arthroscopic surgery for degenerative tears of the meniscus was recently published online in Canadian Medical Association Journal.1 We commend the authors for their timely work summarizing the available scientific evidence up until January 20, 2014.

The authors state in their aim that they "evaluate the efficacy of arthroscopic meniscal debridement in comparison with nonoperative or sham treatments". This is correct for the study comparing arthroscopic surgery to a sham surgery procedure,2 the study comparing arthroscopic surgery to steroid injection,3 and the study comparing arthroscopic surgery to medical exercise therapy.4 However, this aim is incorrectly stated for the studies by Herrlin,5 Katz,6 and Yim7 where exercise was a component of treatment provided to both groups. These three latter studies, together contributing the majority of patients, 522 out of 805, included in this meta-analysis, actually studied the additional effect derived from a combination of arthroscopic surgery and exercise in comparison with exercise alone. Thus, a comparison of the effects from arthroscopic surgery alone to exercise alone is not possible from these three studies. A more correct interpretation of the results from the meta-analysis would therefore be "There is moderate evidence to suggest that there is no additional benefit of arthroscopic meniscal debridement for degenerative meniscal tears compared to exercise, and no benefit in comparison with sham surgery or injection therapy".

References

1. Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta- analysis. CMAJ 2014.

2. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013; 369(26): 2515-24.

3. Vermesan D, Prejbeanu R, Laitin S, et al. Arthroscopic debridement compared to intra-articular steroids in treating degenerative medial meniscal tears. European review for medical and pharmacological sciences 2013; 17(23): 3192-6.

4. Osteras H, Osteras B, Torstensen TA. Medical exercise therapy, and not arthroscopic surgery, resulted in decreased depression and anxiety in patients with degenerative meniscus injury. Journal of bodywork and movement therapies 2012; 16(4): 456-63.

5. Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 2007; 15(4): 393-401.

6. Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 2013; 368(18): 1675- 84.

7. Yim JH, Seon JK, Song EK, et al. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 2013; 41(7): 1565-70.

Conflict of Interest:

None declared