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Research

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

Moin Khan, Nathan Evaniew, Asheesh Bedi, Olufemi R. Ayeni and Mohit Bhandari
CMAJ October 07, 2014 186 (14) 1057-1064; DOI: https://doi.org/10.1503/cmaj.140433
Moin Khan
Division of Orthopaedic Surgery (Khan, Evaniew, Ayeni, Bhandari), Department of Surgery, McMaster University, Hamilton, Ont.; MedSport, Department of Orthopaedic Surgery (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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  • For correspondence: moinkhanmd@gmail.com
Nathan Evaniew
Division of Orthopaedic Surgery (Khan, Evaniew, Ayeni, Bhandari), Department of Surgery, McMaster University, Hamilton, Ont.; MedSport, Department of Orthopaedic Surgery (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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Asheesh Bedi
Division of Orthopaedic Surgery (Khan, Evaniew, Ayeni, Bhandari), Department of Surgery, McMaster University, Hamilton, Ont.; MedSport, Department of Orthopaedic Surgery (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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Olufemi R. Ayeni
Division of Orthopaedic Surgery (Khan, Evaniew, Ayeni, Bhandari), Department of Surgery, McMaster University, Hamilton, Ont.; MedSport, Department of Orthopaedic Surgery (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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Mohit Bhandari
Division of Orthopaedic Surgery (Khan, Evaniew, Ayeni, Bhandari), Department of Surgery, McMaster University, Hamilton, Ont.; MedSport, Department of Orthopaedic Surgery (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
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    Figure 1:

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

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    Figure 2:

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

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    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.37,39,40–43 Note: CI = confidence interval, SD = standard deviation, SMD = standardized mean difference.

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    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.38–41,43 Note: CI = confidence interval, SD = standard deviation, SMD = standardized mean difference.

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    Table 1:

    Studies included in the meta-analysis

    StudyYearCountryPatient characteristicsTreatment arm, no. of patients and description of treatment*Major outcome measuresOA inclusionLoss to follow-up
    Mean age, yrMale sex, %ConservativeSurgical
    Herrlin et al.372007Sweden556143
    Standardized exercise program for 8 wk
    47
    Arthroscopic meniscal débridement
    KOOS, Lysholm Knee Scoring Scale, Tegner Activity Scale, VAS scores at 8 wk, 6 moAhlbäck criteria grade 0–1NR
    Herrlin et al.382013Sweden556049
    Standardized exercise program for 8 wk
    47
    Arthroscopic meniscal débridement
    Lysholm Knee Scoring Scale, Tegner Activity Scale, VAS scores (at rest and with activity) at 24, 60 moAhlbäck criteria grade 0–1C: 2/49
    S: 2/47
    Katz et al.392013United States5843169
    Land-based, individualized physical therapy with progressive home exercise
    161
    Arthroscopic meniscal débridement
    WOMAC-pf, KOOS pain scale, SF-36 physical activity scores at 3, 6, 12 moKellgren–Lawrence grade 0–3C: 2/169
    S: 1/161
    Østerås et al.422012Norway50769
    Exercise program
    3 times/wk for 3 mo
    8
    Arthroscopic meniscal débridement
    KOOS, VAS, HAD scores, quadriceps muscle strength at 3 moKellgren–Lawrence grade 0–20
    Sihvonen et al.402013Finland526176
    Sham surgical procedure
    70
    Arthroscopic meniscal débridement
    Lysholm Knee Scoring Scale, WOMET, VAS, 15D, patient satisfaction scores at 2, 6, 12 moKellgren–Lawrence grade 0–10
    Yim et al.412013South Korea562152
    NSAIDs, 3 wk supervised physical exercise followed by 8 wk home exercise program
    50
    Arthroscopic meniscal débridement
    Lysholm Knee Scoring Scale, VAS, patient satisfaction, Tegner Activity Scale scores at 3, 6 mo, 1, 2 yrKellgren–Lawrence grade 0–1C: 2/54
    S: 4/54
    Vermesan et al.432013Romania582360 knees
    Interarticular steroid injection
    60 knees
    Arthroscopic meniscal débridement
    Oxford Knee Score at 1 mo, 1 yrKellgren–Lawrence grade 0–10
    • Note: 15D = a health-related quality-of-life scale made up of 15 dimensions on a scale of 0 (death) to 1 (full health), C = conservative treatment arm, HAD = Hospital Anxiety and Depression, KOOS = Knee Injury and Osteoarthritis Outcome Score, NR = not reported, NSAIDs = nonsteroidal anti-inflammatory drugs, OA = osteoarthritis, S = surgical treatment arm, SF-36 = Short Form 36, VAS = visual analogue scale, WOMAC-pf = Western Ontario and McMaster Universities Osteoarthritis Index — physical function, WOMET = Western Ontario Meniscal Evaluation Tool.

    • ↵* Conservative to surgical crossover: Herrlin et al.,37 NR; Herrlin et al.,38 27%; Katz et al.,39 30%; Østerås et al.,42 0%; Sihvonen et al.,40 7%; Yim et al.,41 NR; Vermesan et al.,43 17%.

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Canadian Medical Association Journal: 186 (14)
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7 Oct 2014
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Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis
Moin Khan, Nathan Evaniew, Asheesh Bedi, Olufemi R. Ayeni, Mohit Bhandari
CMAJ Oct 2014, 186 (14) 1057-1064; DOI: 10.1503/cmaj.140433

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Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis
Moin Khan, Nathan Evaniew, Asheesh Bedi, Olufemi R. Ayeni, Mohit Bhandari
CMAJ Oct 2014, 186 (14) 1057-1064; DOI: 10.1503/cmaj.140433
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  • Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline
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  • Degenerative meniscus tears - assimilation of evidence and consensus statements across three continents: state of the art
  • Structural pathology is not related to patient-reported pain and function in patients undergoing meniscal surgery
  • Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE study): protocol of a randomised controlled trial
  • Arthroscopic surgery for knee pain: a highly questionable practice without supporting evidence of even moderate quality
  • Return to Work and Sport Following High Tibial Osteotomy: A Systematic Review
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  • The role for arthroscopic partial meniscectomy in knees with degenerative changes: a systematic review
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