Blog | Wednesday, September 3, 2014

QD: News Every Day--No benefit to knee surgery for meniscal tears without osteoarthritis

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.”