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Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review
  1. Romina Brignardello-Petersen1,2,
  2. Gordon H Guyatt1,
  3. Rachelle Buchbinder3,4,
  4. Rudolf W Poolman5,
  5. Stefan Schandelmaier1,5,6,
  6. Yaping Chang1,
  7. Behnam Sadeghirad1,7,
  8. Nathan Evaniew8,
  9. Per O Vandvik9,10
  1. 1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  2. 2Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
  3. 3Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
  5. 5Department of Orthopedic Surgery and Traumatology, Joint Research, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
  6. 6Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
  7. 7HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Medical University Campus, Haft-Bagh Highway, Kerman, Iran
  8. 8Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  9. 9Department of Medicine, Innlandet Hospital Trust-Division Gjøvik, Gjøvik, Norway
  10. 10Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
  1. Correspondence to Romina Brignardello-Petersen; brignarr{at}mcmaster.ca

Abstract

Objective To determine the effects and complications of arthroscopic surgery compared with conservative management strategies in patients with degenerative knee disease.

Design Systematic review.

Main outcome measures Pain, function, adverse events.

Data sources MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and Open Grey up to August 2016.

Eligibility criteria For effects, randomised clinical trials (RCTs) comparing arthroscopic surgery with a conservative management strategy (including sham surgery) in patients with degenerative knee disease. For complications, RCTs and observational studies.

Review methods Two reviewers independently extracted data and assessed risk of bias for patient-important outcomes. A parallel guideline committee (BMJ Rapid Recommendations) provided input on the design and interpretation of the systematic review, including selection of patient-important outcomes. We used the GRADE approach to rate the certainty (quality) of the evidence.

Results We included 13 RCTs and 12 observational studies. With respect to pain, the review identified high-certainty evidence that knee arthroscopy results in a very small reduction in pain up to 3 months (mean difference =5.4 on a 100-point scale, 95% CI 2.0 to 8.8) and very small or no pain reduction up to 2 years (mean difference =3.1, 95% CI −0.2 to 6.4) when compared with conservative management. With respect to function, the review identified moderate-certainty evidence that knee arthroscopy results in a very small improvement in the short term (mean difference =4.9 on a 100-point scale, 95% CI 1.5 to 8.4) and very small or no improved function up to 2 years (mean difference =3.2, 95% CI −0.5 to 6.8). Alternative presentations of magnitude of effect, and associated sensitivity analyses, were consistent with the findings of the primary analysis. Low-quality evidence suggested a very low probability of serious complications after knee arthroscopy.

Conclusions Over the long term, patients who undergo knee arthroscopy versus those who receive conservative management strategies do not have important benefits in pain or function.

Trial registration number PROSPERO CRD42016046242.

  • arthritis
  • Osteoarthritis
  • knee pain
  • meniscus tear
  • GRADE

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors GHG and POV conceived the study idea. RB-P performed the literature search. SS, BS, YC, NE and RB-P performed screening, data abstraction and risk of bias assessments. RB-P performed the data analysis. RB-P, RB and GHG interpreted the data analysis. RB-P and GHG interpreted the data performed certainty of evidence assessments. RB-P wrote the first draft of the manuscript. GHG, POV, RB and RP critically revised the manuscript. All authors approved the final version of the manuscript. RB-P had full access to all of the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. RB-P is guarantor.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. RB is funded by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf

  • Disclaimer All authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other financial relationships that could appear to have influenced the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data are available in the publication of the BMJ Rapid Recommendation in MAGICapp.

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