Arthroscopic partial meniscectomy combined with medical exercise therapy versus isolated medical exercise therapy for degenerative meniscal tear: A meta-analysis of randomized controlled trials

Pan, Huagang; Zhang, Peng; Zhang, Zhaodong; Yang, Quan

doi:10.1016/j.ijsu.2020.05.035

Cited by 19 publications

(11 citation statements)

References 24 publications

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“…Arthroscopic partial meniscectomy (APM) has been advocated to manage degenerative and obstructive (i.e., inducing locking of the knee joint) meniscal damage [ 8 , 22 ]. However, in adults with degenerative and nonobstructive meniscal symptoms the superiority of APM over a well-structured physical therapy (PT) programme is debated [ 1 , 9 , 19 , 35 , 44 , 47 , 54 ]. Previous systematic reviews were inconsistent and found none to slightly better outcome in APM compared to PT [ 1 , 9 , 19 , 33 , 35 , 44 , 47 , 54 , 57 , 59 ].…”

Section: Introductionmentioning

confidence: 99%

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

Migliorini

Oliva

Eschweiler

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose It is unclear whether the results of arthroscopic partial meniscectomy (APM) are comparable to a structured physical therapy (PT). This systematic review investigated efficacy of APM in the management of symptomatic meniscal damages in middle aged patients. Current available randomised controlled trials (RCTs) which compared APM performed in isolation or combined with physical therapy versus sham arthroscopy or isolated physical therapy were considered in the present systematic review. Methods This systematic review was conducted according to the 2020 PRISMA statement. All the level I RCTs which investigated the efficacy of AMP were accessed. Studies which included elderlies with severe OA were not eligible, nor were those in which APM was combined with other surgical intervention or in patients with unstable knee or with ligaments insufficiency. The risk of bias was assessed using the software Review Manager 5.3 (The Nordic Cochrane Collaboration, Copenhagen). To rate the quality of evidence of collected outcomes, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used. Results Data from 17 studies (2037 patients) were collected. 48.5% (988 of 2037 patients) were women. The mean age of the patients was 52.7 ± 3.9 years, the mean BMI 27.0 ± 1.3 kg/m2. The current evidence suggests no difference in functional PROMs (quality of the evidence: high), clinical PROMs (quality of the evidence: high), pain (quality of the evidence: high), quality of life (quality of the evidence: high), physical performance measures (quality of the evidence: moderate), and OA progression (quality of the evidence: moderate). Conclusions The benefits of APM in adults with degenerative and nonobstructive meniscal symptoms are limited. The current evidence reports similarity in the outcome between APM and PT. Further long-term RCTs are required to investigate whether APM and PT produce comparable results using validated and reliable PROMs. Moreover, future RCTs should investigate whether patients who might benefit from APM exist, clarifying proper indications and outcomes. High quality investigations are strongly required to establish the optimal PT regimes. Level of evidence Level I.

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Section: Introductionmentioning

confidence: 99%

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

Migliorini

Oliva

Eschweiler

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…Помимо этого существуют и другие рекомендации: ESSKA (2017) [24], NICE [25], BASK [26], шведские национальные рекомендации [8], позиции ряда профессиональных сообществ Канады [27], Австралии [28] и метаанализы. Мы обнаружили 13 метаанализов [29,30,31,32,33,34,35,36,37,38,39,40,41] и еще 6 метаанализов от наших китайских коллег, которые весьма активно публикуют их в последние два-три года [42,43,44,45,46,47]. Во всех этих документах существуют разнообразные вариации формулировок.…”

Section: таблица 1 эволюция рекомендаций Aaos по артроскопии при осте...unclassified

Arthroscopic Meniscectomy for Knee Osteoarthritis: the Gap Between Evidence Based Medicine and Expert Opinion

Сараев¹,

Корнилов²,

Середа³

et al. 2022

Traumatology and Orthopedics of Russia

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For many decades arthroscopy considered to be the least invasive procedure among all surgical interventions for treatment of knee osteoarthritis (OA). In the beginning of XXI century several randomized clinical studies (RCS) demonstrated inefficiency of lavage and debridement for knee OA. The evidence regarding partial meniscectomy for these category of patients remained uncertain. Therefore the published clinical guidelines are either controversial or inconclusive. The aim of this study was to critically review the current RCS and meta-analyses of RCS as well as actual clinical guidelines of international orthopedic societies and compare them to expert opinions. We searched PubMed and E-library databases for high evidence research published from 2015 to 2022 and analyzed the current clinical guidelines dedicated to partial meniscectomy for knee OA. 60 specialized in this field orthopedic surgeons interviewed anonymously to clarify the decision making process in real clinical practice The evidence is that more than 2/3 of knee OA patients with degenerative meniscal tear benefit from non-surgical treatment therefore indication for arthroscopic partial meniscectomy is limited. The majority of current clinical guidelines consider surgery as an second option if conservative treatment failed and only for non-advanced knee OA. On the contrary experts interview demonstrated the lack of standardized approach as well as a lot of controversies in clinical decision making. The future research dedicated to partial meniscectomy in knee OA should be appropriately designed to clearly differentiate the sub-population of patient who may benefit from arthroscopy in the long-term without carrying the risk of rapid disease progression with premature conversion to arthroplasty.

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“…About 450,000 arthroscopic partial meniscectomies are performed annually in the United States for this indication on adults 45 to 64 years old ( 3 , 4 ). A growing body of research, including results from eight randomized controlled trials (RCTs) ( 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ) and seven meta‐analyses ( 13 , 14 , 15 , 16 , 17 , 18 , 19 ), indicates that participants with meniscal tear who are randomized to receive arthroscopic partial meniscectomy experience similar or only slightly better outcomes than those randomized to receive PT or sham surgery. Nonetheless, the applicability of these findings to clinical practice is limited by the high rates of crossover to surgery observed among participants randomized to PT.…”

Section: Introductionmentioning

confidence: 99%

Cost‐Effectiveness of Arthroscopic Partial Meniscectomy and Physical Therapy for Degenerative Meniscal Tear

Williams

Katz

Leifer

et al. 2022

ACR Open Rheumatology

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Objective We examined the cost‐effectiveness of treatment strategies for concomitant meniscal tear and knee osteoarthritis (OA) involving arthroscopic partial meniscectomy surgery and physical therapy (PT). Methods We used the Osteoarthritis Policy Model, a validated Monte Carlo microsimulation, to compare three strategies, 1) PT‐only, 2) immediate surgery, and 3) PT + optional surgery, for participants whose pain persists following initial PT. We modeled a cohort with baseline meniscal tear, OA, and demographics from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of arthroscopic partial meniscectomy versus PT. We estimated risks and costs of arthroscopic partial meniscectomy complications and accounted for heightened OA progression post surgery using published data. We estimated surgery use rates and treatment efficacies using MeTeOR data. We considered a 5‐year time horizon, discounted costs, and quality‐adjusted life‐years (QALYs) 3% per year and conducted sensitivity analyses. We report incremental cost‐effectiveness ratios. Results Relative to PT‐only, PT + optional surgery added 0.0651 QALY and $2,010 over 5 years (incremental cost‐effectiveness ratio = $30,900 per QALY). Relative to PT + optional surgery, immediate surgery added 0.0065 QALY and $3080 (incremental cost‐effectiveness ratio = $473,800 per QALY). Incremental cost‐effectiveness ratios were sensitive to optional surgery efficacy in the PT + optional surgery strategy. In the probabilistic sensitivity analysis, PT + optional surgery was cost‐effective in 51% of simulations at willingness‐to‐pay thresholds of both $50,000 per QALY and $100,000 per QALY. Conclusion First‐line arthroscopic partial meniscectomy has a prohibitively high incremental cost‐effectiveness ratio. Under base case assumptions, second‐line arthroscopic partial meniscectomy offered to participants with persistent pain following initial PT is cost‐effective at willingness‐to‐pay thresholds between $31,000 and $473,000 per QALY. Our analyses suggest that arthroscopic partial meniscectomy can be a high‐value treatment option for patients with meniscal tear and OA when performed following an initial PT course and should remain a covered treatment option.

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Arthroscopic partial meniscectomy combined with medical exercise therapy versus isolated medical exercise therapy for degenerative meniscal tear: A meta-analysis of randomized controlled trials

Cited by 19 publications

References 24 publications

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

Arthroscopic Meniscectomy for Knee Osteoarthritis: the Gap Between Evidence Based Medicine and Expert Opinion

Cost‐Effectiveness of Arthroscopic Partial Meniscectomy and Physical Therapy for Degenerative Meniscal Tear

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