Arthroscopic debridement for knee osteoarthritis

Laupattarakasem, Wiroon; Laopaiboon, Malinee; Sumananont, Chat

doi:10.1002/14651858.cd005118

Cited by 15 publications

(15 citation statements)

References 16 publications

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“…Previous systematic reviews have investigated the benefits of knee arthroscopy in patients with established knee osteoarthritis or no/mild knee osteoarthritis. 80 81 To the best of our knowledge, ours is the first systematic review and meta-analysis to include both benefits and harms of arthroscopic surgery and to include the whole continuum of degenerative knee disease, ranging from patients with degenerative meniscal tears without radiographic changes to those with meniscal tears and other joint changes combined with more severe radiographic changes. We included all identified randomised controlled trials of arthroscopic surgery for the degenerative knee comparing interventions including arthroscopic surgery with control treatments.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms

et al. 2015

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ObjectiveTo determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease.DesignSystematic review and meta-analysis.Main outcome measuresPain and physical function.Data sourcesSystematic searches for benefits and harms were carried out in Medline, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2014. Only studies published in 2000 or later were included for harms.Eligibility criteria for selecting studiesRandomised controlled trials assessing benefit of arthroscopic surgery involving partial meniscectomy, debridement, or both for patients with or without radiographic signs of osteoarthritis were included. For harms, cohort studies, register based studies, and case series were also allowed.ResultsThe search identified nine trials assessing the benefits of knee arthroscopic surgery in middle aged and older patients with knee pain and degenerative knee disease. The main analysis, combining the primary endpoints of the individual trials from three to 24 months postoperatively, showed a small difference in favour of interventions including arthroscopic surgery compared with control treatments for pain (effect size 0.14, 95% confidence interval 0.03 to 0.26). This difference corresponds to a benefit of 2.4 (95% confidence interval 0.4 to 4.3) mm on a 0–100 mm visual analogue scale. When analysed over time of follow-up, interventions including arthroscopy showed a small benefit of 3–5 mm for pain at three and six months but not later up to 24 months. No significant benefit on physical function was found (effect size 0.09, −0.05 to 0.24). Nine studies reporting on harms were identified. Harms included symptomatic deep venous thrombosis (4.13 (95% confidence interval 1.78 to 9.60) events per 1000 procedures), pulmonary embolism, infection, and death.ConclusionsThe small inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time and absent at one to two years after surgery. Knee arthroscopy is associated with harms. Taken together, these findings do not support the practise of arthroscopic surgery for middle aged or older patients with knee pain with or without signs of osteoarthritis.Systematic review registrationPROSPERO CRD42014009145.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms

et al. 2015

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“…12 The main objective of a future Cochrane review is to identify the appropriate use of arthroscopic debridement in knee osteoarthritis; perhaps this review will provide some clarity as well as accurate indications for arthroscopic debridement of the knee in elderly patients. 23…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Debridement for Grade III and IV Chondromalacia of the Knee in Patients Older Than 60 Years

Bekerom

Patt²,

Rutten³

et al. 2010

J Knee Surg

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“…A recent meta‐analysis performed for an EMB database of intervention recommendations found that there is ‘gold’ level evidence that knee lavage and debridement do not improve knee function or reduce pain, and do not have any benefit over placebo surgery or non‐surgical approaches like physical therapy. Research has not yet identified why these surgical interventions fail to improve knee function or alleviate pain.…”

Section: Failures Of Mechanistic Reasoningmentioning

confidence: 99%

Mechanisms: what are they evidence for in evidence‐based medicine?

Andersen

2012

Evaluation Clinical Practice

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Even though the evidence-based medicine (EBM) movement labels mechanisms a low quality form of evidence, consideration of the mechanisms on which medicine relies, and the distinct roles that mechanisms might play in clinical practice, offers a number of insights into EBM itself. In this paper, I examine the connections between EBM and mechanisms from several angles. I diagnose what went wrong in two examples where mechanistic reasoning failed to generate accurate predictions for how a dysfunctional mechanism would respond to intervention. I then use these examples to explain why we should expect this kind of mechanistic reasoning to fail in systematic ways, by situating these failures in terms of evolved complexity of the causal system(s) in question. I argue that there is still a different role in which mechanisms continue to figure as evidence in EBM: namely, in guiding the application of population-level recommendations to individual patients. Thus, even though the evidence-based movement rejects one role in which mechanistic reasoning serves as evidence, there are other evidentiary roles for mechanistic reasoning. This renders plausible the claims of some critics of EBM who point to the ineliminable role of clinical experience. Clearly specifying the ways in which mechanisms and mechanistic reasoning can be involved in clinical practice frames the discussion about EBM and clinical experience in more fruitful terms.

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Arthroscopic debridement for knee osteoarthritis

Cited by 15 publications

References 16 publications

Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms

Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms

Arthroscopic Debridement for Grade III and IV Chondromalacia of the Knee in Patients Older Than 60 Years

Mechanisms: what are they evidence for in evidence‐based medicine?

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