Clinician Article
Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review.
PMID: 28495819
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Surgery - OrthopaedicsRelevance - 7/7
Newsworthiness - 5/7 -
Physical Medicine and RehabilitationRelevance - 6/7
Newsworthiness - 6/7 -
Family Medicine (FM)/General Practice (GP)Relevance - 6/7
Newsworthiness - 5/7 -
General Internal Medicine-Primary Care(US)Relevance - 6/7
Newsworthiness - 5/7 -
RheumatologyRelevance - 5/7
Newsworthiness - 6/7
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.
Clinical Comments
Family Medicine (FM)/General Practice (GP)
This is the SR that informs the patient decision aid and reassures me that the `science is right` for it. The decision aid is what I will use with patients wanting referral for arthroscopy of the knee -- lovely. Wouldn`t it be good if ALL SRs provided something like that for immediate application in shared decision-making?
General Internal Medicine-Primary Care(US)
The surgeon says "a chance to cut is a chance to cure," and the internist says "there is no case so bad that it cannot be made worse by surgery." This paper should give pause to those considering surgery except in very select cases (e.g., locking, lack of full extension, etc).
General Internal Medicine-Primary Care(US)
Comprehensive review of the studies, but not particularly easy to sift through the data. Arthroscopy is not useful for pain or function in osteoarthritis compared with conservative therapy. This review certainly seems to support that conclusion.
Rheumatology
Although knee arthroscopy is a safe surgical procedure, the results of this study found that it is worthless in knee OA because short-term results and outcomes after two years showed no benefits in terms of pain and function. Studies on different degrees of knee involvement and evaluation after longer periods (5 or 10 years) should be interesting to perform to investigate whether arthroscopy could prevent future joint replacement.
Surgery - Orthopaedics
We all know it but didn`t dare to act on it! Because if we don`t scope the knee, our colleagues in the other hospital will.
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