Arthroscopic Debridement versus Non-operative Treatment for Degenerative Meniscal Tear: A Systematic Review and Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIUYi ¹ , YANGDe-sheng ¹ , Aili·Rehei ¹ , YEYuan-zheng ² ,  CAOLi ³

1. Inpatient Area 1 of Pediatric Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;
2. Heart function department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;
3. Department of Joint Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

CAOLi, Email: xjbone@21cn.com

Keywords：

Arthroscopic debridement; Menisci; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160213

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the effectiveness of arthroscopic debridement versus non-operative treatment for degenerative meniscal tear. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 7, 2015), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about arthroscopic debridement versus non-operative treatment for degenerative meniscal tear from inception to July 2015. The meta-analysis was conducted using RevMan 5.3 software. Results A total of nine RCTs involving 1 023 patients were included. The results of meta-analysis showed that:there were no significant differences between two groups at different follow-up time points in knee scoring scale (less than 6 months:SMD=0.12, 95%CI -0.11 to 0.35, P=0.30; 1 year:SMD=-0.03, 95%CI -0.18 to 0.11, P=0.65; 2 years:SMD=-0.07, 95%CI -0.32 to 0.19, P=0.61) and pain score (less than 6 months:MD=0.30, 95%CI -0.10 to 0.70, P=0.14; 1 year:MD=0.10, 95%CI -0.40 to 0.60, P=0.70; 2 years:MD=0.02, 95%CI -0.52 to 0.92, P=0.90). Conclusion Current evidence suggests that arthroscopic debridement hasn't better effective than non-operative treatment for degenerative meniscal tear, however, due to the limited quantity of the included studies, the above conclusion still need more high quality research to be verified.

Citation： LIUYi, YANGDe-sheng, Aili·Rehei, YEYuan-zheng, CAOLi. Arthroscopic Debridement versus Non-operative Treatment for Degenerative Meniscal Tear: A Systematic Review and Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(12): 1408-1413. doi: 10.7507/1672-2531.20160213 Copy

1.	Buchbinder R. Meniscectomy in patients with knee osteoarthritis and a meniscal tear? N Engl J Med, 2013, 368(18):1740-1741.
2.	Marx RG. Arthroscopic surgery for osteoarthritis of the knee. N Engl J Med, 2008, 359(11):1169-1170.
3.	Gross DE, Brenner SL, Esformes I, et al. Arthroscopic treatment of degenerative joint disease of the knee. Orthopedics, 1991, 14(12):1317-1321.
4.	Bonamo JJ, Kessler KJ, Noah J. Arthroscopic meniscectomy in patients over the age of 40. Am J Sports Med, 1992, 20(4):422-429.
5.	Rathleff CR, Cavallius C, Jensen H P, et al. Successful conservative treatment of patients with MRI-verified meniscal lesions. Knee Surg Sports Traumatol Arthrosc, 2015, 23(1):178-183.
6.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration. 2011. Available at:www.cochranehandbook.org.
7.	Herrlin SV, Wange PO, Lapidus G, et al. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc, 2013, 21(2):358-364.
8.	Herrlin S, Hållander M, Wange P, et al. Arthroscopic or conservative treatment of degenerative medial meniscal tears:a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc, 2007, 15(4):393-401.
9.	Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med, 2013, 368(18):1675-1684.
10.	Østerås H, Østerås B, Torstensen TA. Medical exercise therapy, and not arthroscopic surgery, resulted in decreased depression and anxiety in patients with degenerative meniscus injury. J Bodyw Mov Ther, 2012, 16(4):456-463.
11.	Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med, 2013, 369(26):2515-2524.
12.	Stensrud S, Risberg M A, Roos E M. Effect of exercise therapy compared with arthroscopic surgery on knee muscle strength and functional performance in middle-aged patients with degenerative meniscus tears:a 3-Mo follow-up of a randomized controlled trial. Am J Phys Med Rehabil, 2015, 94(6):460-473.
13.	Vermesan D, Prejbeanu R, Laitin S, et al. Arthroscopic debridement compared to intra-articular steroids in treating degenerative medial meniscal tears. Eur Rev Med Pharmacol Sci, 2013, 17(23):3192-3196.
14.	Yim JH, Seon JK, Song EK, et al. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med, 2013, 41(7):1565-1570.
15.	付东, 单连成, 蔡郑东, 等. 退行性半月板撕裂患者理疗与关节镜下手术疗效的前瞻性比较研究. 中国骨与关节杂志, 2014, 3(6):429-432.
16.	Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med, 2008, 359(11):1108-1115.

1. Buchbinder R. Meniscectomy in patients with knee osteoarthritis and a meniscal tear? N Engl J Med, 2013, 368(18):1740-1741.
2. Marx RG. Arthroscopic surgery for osteoarthritis of the knee. N Engl J Med, 2008, 359(11):1169-1170.
3. Gross DE, Brenner SL, Esformes I, et al. Arthroscopic treatment of degenerative joint disease of the knee. Orthopedics, 1991, 14(12):1317-1321.
4. Bonamo JJ, Kessler KJ, Noah J. Arthroscopic meniscectomy in patients over the age of 40. Am J Sports Med, 1992, 20(4):422-429.
5. Rathleff CR, Cavallius C, Jensen H P, et al. Successful conservative treatment of patients with MRI-verified meniscal lesions. Knee Surg Sports Traumatol Arthrosc, 2015, 23(1):178-183.
6. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration. 2011. Available at:www.cochranehandbook.org.
7. Herrlin SV, Wange PO, Lapidus G, et al. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc, 2013, 21(2):358-364.
8. Herrlin S, Hållander M, Wange P, et al. Arthroscopic or conservative treatment of degenerative medial meniscal tears:a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc, 2007, 15(4):393-401.
9. Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med, 2013, 368(18):1675-1684.
10. Østerås H, Østerås B, Torstensen TA. Medical exercise therapy, and not arthroscopic surgery, resulted in decreased depression and anxiety in patients with degenerative meniscus injury. J Bodyw Mov Ther, 2012, 16(4):456-463.
11. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med, 2013, 369(26):2515-2524.
12. Stensrud S, Risberg M A, Roos E M. Effect of exercise therapy compared with arthroscopic surgery on knee muscle strength and functional performance in middle-aged patients with degenerative meniscus tears:a 3-Mo follow-up of a randomized controlled trial. Am J Phys Med Rehabil, 2015, 94(6):460-473.
13. Vermesan D, Prejbeanu R, Laitin S, et al. Arthroscopic debridement compared to intra-articular steroids in treating degenerative medial meniscal tears. Eur Rev Med Pharmacol Sci, 2013, 17(23):3192-3196.
14. Yim JH, Seon JK, Song EK, et al. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med, 2013, 41(7):1565-1570.
15. 付东, 单连成, 蔡郑东, 等. 退行性半月板撕裂患者理疗与关节镜下手术疗效的前瞻性比较研究. 中国骨与关节杂志, 2014, 3(6):429-432.
16. Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med, 2008, 359(11):1108-1115.

Chinese Journal of Evidence-Based Medicine

Arthroscopic Debridement versus Non-operative Treatment for Degenerative Meniscal Tear: A Systematic Review and Meta-analysis

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