Orthopedics & Rheumatology

Biography

Biography: Moin Khan

Abstract

Introduction: Partial meniscectomy is one of the most commonly performed orthopaedic procedures. Controversy exists with regards to its efficacy in the setting of degenerative meniscal tears. This systematic review and meta-analysis evaluates the efficacy of arthroscopic partial meniscectomy in the setting of mild to no concurrent osteoarthritis of the knee in comparison to non-operative or sham treatments. Methods: Two reviewers independently screened MEDLINE, EMBASE, PUBMED and Cochrane databases for all eligible studies. Only randomized control trials published from 1946 through to Jan 2014 were included. A risk of bias assessment was conducted for all included studies and outcomes were pooled using a random effects model. Outcomes were dichotomized to short-term (< 6 months) and long-term (< 2 years) data. The quality of the evidence was assessed and confidence in recommendations was developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Seven randomized control trials were included in this review. Six of the seven included studies had moderate to significant risk of bias. The pooled treatment effect across studies did not demonstrate a statistically significant or minimally patient important difference (MID) between treatment arms for functional outcomes (SMD 0.07, 95% CI -0.10 to 0.23, p=0.43) (I2=20%) or pain relief (MD= -0.06, 95% CI -0.28, 0.15, p=0.57, I2=0%) at two years. Short-term functional outcomes between groups were statistically significant but did not exceed the threshold for MID. (SMD 0.25, 95% CI 0.02 to 0.48, p=0.04). (I2=56%) A priori subgroup analysis related to conservative treatment resulted in substantial decrease in heterogeneity. Sensitivity analyses related to sample size and missing data did not have a significant effect on treatment effect. Conclusions: According to the GRADE approach, there is moderate evidence to suggest there is no benefit of arthroscopic partial meniscectomy for degenerative meniscal tears in comparison to nonoperative or sham treatments for individuals with mild or no concomitant osteoarthritis. A trial of non-operative management should be the first line treatment in such individuals. Future research into identifying indications and ideal patient selection is required with regards to prognostic factors, which may influence outcomes following surgical and conservative treatment.