Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus

Beaufils, P; Becker, Rolf; Kopf, Sebastian; Englund, Martin; Verdonk, Robert C.; Ollivier, M.; Seil, Romain

doi:10.1016/j.orthtr.2017.05.002

Cited by 61 publications

(109 citation statements)

References 28 publications

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“…34,36 Recently, a clinical guideline for degenerative knee disease and meniscal tears strongly recommended against arthroscopic surgery in nearly all patients with degenerative knee disease. 45 Therefore, nonsurgical treatment should be the first-line treatment 3,29 ; indeed, in the present study, prior physical therapy was an inclusion criterion. Exercise therapy and meniscectomy were shown to be equally effective in reducing knee pain and increasing function and performance in patients with degenerative meniscal injuries.…”

Section: Discussionmentioning

confidence: 90%

“…49 The mechanisms underlying the effects of exercise interventions include increased muscle strength, enhanced proprioception, and improved range of motion. 43 When the effects of nonsurgical treatment are unsatisfactory, arthroscopic partial meniscectomy can be considered 3,29,33 because some subgroups of patients are known to benefit from arthroscopic surgery. 21 It remains a challenge in clinical decision making to identify which subgroups of patients with degenerative meniscal injuries are most likely to benefit from knee arthroscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

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Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

Sonesson

Kvist

Yakob

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Arthroscopic meniscal surgery is a common orthopaedic procedure in middle-aged patients, but the efficacy of this procedure has been questioned. In this study, we followed up the only randomized controlled trial that has shown a 1-year benefit from knee arthroscopic surgery with an exercise program compared with an exercise program alone. Purpose: To (1) evaluate whether knee arthroscopic surgery combined with an exercise program provided an additional 5-year benefit compared with an exercise program alone in middle-aged patients with meniscal symptoms, (2) determine whether baseline mechanical symptoms affected the outcome, and (3) compare radiographic changes between treatment groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to either a 3-month exercise program (nonsurgery group) or to the same exercise program plus knee arthroscopic surgery (surgery group) within 4 weeks. Radiographs were assessed, according to the Kellgren-Lawrence grade, at baseline and at the 5-year follow-up. The primary outcome was the change in Knee injury and Osteoarthritis Outcome Score (KOOS)–Pain (KOOSPAIN) subscore from baseline to the 5-year follow-up. We performed an as-treated analysis. Results: A total of 102 patients completed the 5-year questionnaire. At the 5-year follow-up, both groups had significant improvement in KOOSPAIN subscores, although there was no significant change from the 3-year scores. There was no between-group difference in the change in the KOOSPAIN subscore from baseline to 5 years (3.2 points [95% CI, –6.1 to 12.4]; adjusted P = .403). In the surgery group, improvement was greater in patients without mechanical symptoms than in those with mechanical symptoms (mean difference, 18.4 points [95% CI, 8.7 to 28.1]; P < .001). Radiographic deterioration occurred in 60% of patients in the surgery group and 37% of those in the nonsurgery group ( P = .060). Conclusion: Knee arthroscopic surgery combined with an exercise program provided no additional long-term benefit after 5 years compared with the exercise program alone in middle-aged patients with meniscal symptoms. Surgical outcomes were better in patients without mechanical symptoms than in patients with mechanical symptoms during the preoperative period. Radiographic changes did not differ between treatment groups. Registration: NCT01288768 ( ClinicalTrials.gov identifier).

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

Sonesson

Kvist

Yakob

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…The effectiveness of arthroscopic partial meniscectomy (APM) for a ruptured meniscus of the knee has been under debate in scientific journals. [1][2][3][4][5][6][7][8][9] The conclusions of this debate are based on assessments of risk of bias and generalizability of findings in randomized controlled trials (RCTs). [10][11][12][13] However, a more comprehensive description of study characteristics can be obtained using the methodology for the benchmarking controlled trials (BCTs), which are intended for the assessment of validity and generalizability of findings in observational effectiveness studies.…”

Section: Introductionmentioning

confidence: 99%

Validity and generalizability of findings of randomized controlled trials on arthroscopic partial meniscectomy of the knee

Malmivaara

2018

Scandinavian Med Sci Sports

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The validity and generalizability of evidence from trials on arthroscopic partial meniscectomy (APM) for a ruptured meniscus of the knee has been debated in scientific journals. The aim of this paper was to assess the validity and generalizability of evidence for trials on effectiveness of APM by a novel Benchmarking method; to compare this assessment with established assessment methods; and to make an overall assessment of the current evidence on validity and generalizability of findings. Literature search was undertaken to find all randomized controlled trials. The benchmarking method, the Cochrane method for the assessment of validity of RCTs, and CONSORT method for the assessment of generalizability of findings were used. The data were extracted and checked for accuracy twice. Seven RCTs were found, of which 2 were double blinded. The benchmarking method indicated that only one trial, assessing real-world effectiveness, had recruited patients comprehensively from the catchment area and showed clinically important effectiveness for APM. All trials had deficiencies in reporting of baseline characteristics and adherence to interventions. In 5 trials, the crossover to surgery from conservative treatment arm was between 19 and 36 percent. The benchmarking method indicates that APM may be an effective treatment for meticulously selected patients, or when APM is targeted to those patients who do not respond to the conservative treatment. There is a need for more sham-controlled and real-world effectiveness trials reporting comprehensively patient characteristics and adherence to interventions, preferably in a representative sample of patients living in the recruitment area.

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“…The risk of pre-or post-operative complications in knee arthroscopy is low, but not negligible (42). The time has come to abandon the myth that arthroscopic surgery is a relevant intervention for the great majority of patients who suffer from atraumatic and degenerative knee disorders (11,43,44). We should expect that within a short time, knee arthroscopy will be restricted to indications where it will provide a proven benefit, primarily traumatic meniscus injuries in people younger than 35 years (10)…”

Section: Arthroscopy For Atraumatic and Degenerative Knee Disordersmentioning

confidence: 99%

Atraumatic knee pain

Holtedahl¹

2018

Tidsskriftet

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Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus

Cited by 61 publications

References 28 publications

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

Validity and generalizability of findings of randomized controlled trials on arthroscopic partial meniscectomy of the knee

Atraumatic knee pain

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