Arthroscopic surgery may not help degenerative meniscal tears

Arthroscopic surgery may have little or no benefit for degenerative tears of the meniscus, according to a new study.

Researchers performed a systematic review and meta-analysis to evaluate the efficacy of arthroscopic debridement compared with nonoperative or sham treatment in patients who had knee pain and mild or no knee osteoarthritis. MEDLINE, Embase, and the Cochrane databases were searched for randomized, controlled trials that were published from 1946 through mid-January 2014. A total of 7 trials involving 805 patients (811 knees) were included. Outcomes were function and pain relief over the short term (<6 months) and long term (<2 years). The study results were published online Aug. 25 by CMAJ.

Five of the included trials were conducted in Europe, 1 was conducted in the U.S., and 1 was conducted in South Korea. Four were single-center trials, and 3 were multicenter trials. Patients' mean age was 56 years. The authors found no significant or minimally important difference between treatment arms for long-term functional outcomes (standardized mean difference, 0.07; 95% CI, −0.10 to 0.23), while short-term functional outcomes between treatment arms differed significantly (standardized mean difference, 0.25; 95% CI, 0.02 to 0.48; P<0.04), but not enough to meet the minimally important difference threshold. The minimally important difference was defined as “the smallest effect that an informed patient would perceive as valuable enough to justify a change in therapeutic management when weighing the anticipated benefits against the possible harms of an intervention.” Pain scores did not improve significantly in the short term (mean difference, 0.20; 95% CI, −0.67 to 0.26) or the long term (mean difference, −0.06; 95% CI, −0.28 to 0.15) with arthroscopic surgery.

The authors noted that some outcome measures were combined in their pooled analyses and that some SDs were estimated based on similar studies when data from the included studies could not be obtained, among other limitations. However, they concluded that based on moderate evidence, arthroscopic meniscal debridement offers no benefit for degenerative meniscal tears compared with nonoperative or sham treatment in middle-aged patients who have mild or no concomitant osteoarthritis.

Given these findings, they said, nonoperative interventions should be attempted first in this patient population. They also called for future studies to compare direct and indirect costs of arthroscopic debridement and nonoperative therapies, as well as more research to help clinicians determine which types of patients might benefit from surgery. “Comparison of various rehabilitation protocols, adjunct modalities and injections will further define optimal initial nonoperative management,” the authors wrote.