Moderate evidence suggests that there is no benefit to arthroscopic meniscal debridement for degenerative meniscal tears compared to nonoperative or sham treatments in middle-aged patients with mild or no osteoarthritis, concluded a meta-analysis. Instead, nonoperative management should be tried first.
Seven randomized, controlled trials (total: 811 knees among 805 patients with a mean age of 56 ±3.2 years) were included. Results appeared online Aug. 25 at CMAJ.
The pooled treatment effect of arthroscopic surgery did not show a significant or minimally important difference (MID) between treatment arms for long-term functional outcomes (standardized mean difference [SMD], 0.07; 95% CI; –0.10 to 0.23).
Arthroscopic debridement resulted in a significant improvement in short-term function across 6 trials, but did not exceed the threshold for MID (SMD, 0.25; 95% CI, 0.02 to 0.48). Arthroscopic surgery did not result in a significant improvement across in pain scores in the short term across 4 trials (mean difference [MD] 0.20; 95% CI, –0.67 to 0.26) or in the long term across 3 trials (MD, –0.06; 95% CI, –0.28 to 0.15).
Researchers wrote, “Although not without limitations, this tool aids clinicians in evaluating therapeutic options and determining whether significant outcomes will have clinically meaningful implications. A limitation of this approach is that MIDs may be context-specific and may not be applicable across treatments or populations. Minimal important differences must therefore be defined for specific populations to provide useful guidance to users of these instruments.”
Blog | Wednesday, September 3, 2014
