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Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review
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  • Published on:
    Don't throw the baby out with the bath water
    • Jan J. Rongen, MD PhD Radboudumc, Radboud Institute for Health Sciences
    • Other Contributors:
      • Gerjon Hannink, PhD
      • Maroeska M. Rovers, Professor

    In their recently published meta-analyses Brignardello-Petersen et al. (1) concluded that knee arthroscopy including partial meniscectomy for degenerative knee disease provides very small benefits in pain and function over conservative therapy in the short term, but that the evidence fails to support any long term effect. They also claimed that there was no evidence of any subgroup of patients more likely to benefit from the procedure. However, this statement is not substantiated by the results of their systematic review and meta-analysis. Besides, the design of their study is not suited for evaluating subgroups. By making such an unsubstantiated claim, and subsequently adopting it in a clinical practice guideline (2), the risk is that we “throw the baby out with the bath water”.

    Despite the accumulated evidence that questions the effectiveness of knee arthroscopy for degenerative meniscus tears, clinical practice does not seem to change.(3-7) Hence, the key question is what information is required in order to effectively change the practice of knee arthroscopy in degenerative knee disease.
    Orthopedic surgeons have expressed concerns about the generalisability of the individual trial results, and point out that the study populations may not be representative to the subjects they select for surgery in their day-to-day clinical practice.(8-18) These concerns point to the common perception that some subgroups of patients may still benefit from the procedure. Hen...

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    Conflict of Interest:
    None declared.