Key messages from scientific research that's ready to be acted on
Got It, Hide thisBrignardello-Petersen R, Guyatt GH, Buchbinder R, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open. 2017 May 11;7(5):e016114.
Siemieniuk RA, Harris IA, Agoritsas T, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ. 2017 May 10;357:j1982.
In people with knee pain due to degenerative knee disease (which may include osteoarthritis and/or meniscal tears), is arthroscopic surgery better than placebo or nonsurgical therapy for improving pain, function, and quality of life?
Degenerative knee disease is often associated with osteoarthritis or tears in the knee cartilage. It can cause knee pain, stiffness, swelling, and tenderness, and it often reduces quality of life.
Degenerative knee disease can be treated with pain medications, corticosteroid injections, weight loss if the person is overweight, physical therapy, exercise, and surgery, including arthroscopic surgery, knee replacement surgery, or osteotomy (removing or adding bone). Knee replacement surgery is the only definitive therapy, but it is only done in people with severe disease that has not improved with nonsurgical therapy. Arthroscopic knee surgery is done with small tools, including a camera, inserted through small cuts in the knee. It can include partial meniscectomy (removal of damaged knee cartilage) and/or debridement (cleaning out knee debris).
The researchers did a systematic review, searching for studies up until August 2016.
They found 13 randomized controlled trials with 1665 people (average age 49 to 63 years).
The key features of the studies were:
An international panel of experts reviewed the results of the studies and made recommendations. Recommendations could be strong (benefits outweigh harms for almost everyone or vice versa) or weak (benefits outweigh harms for most people but not everyone or vice versa). The panel included surgeons, other medical specialists and health care workers, research methods specialists, and patients.
Compared with conservative therapy, arthroscopic surgery:
Based on the results of the studies, the expert panel made one strong recommendation.
An international expert panel recommends against the use of arthroscopic surgery for people with degenerative knee disease (strong recommendation).
Follow-up periods | Outcomes | Number of trials (people) | Absolute effect of arthroscopic surgery* | Quality of the evidence† |
3 months | Pain | 10 trials (1231 people) | Very small improvement. Pain scores improved by 5.4 points out of 100 (from as little as 1.9 points to as much as 8.8 points). | High |
| Function | 7 trials (964 people) | Very small improvement. Function scores improved by 4.9 points out of 100 (from as little as 1.5 points to as much as 8.4 points). | Moderate |
| Quality of life | 1 trial (120 people) | No improvement | Low |
1 to 2 years | Pain | 8 trials (1097 people) | No improvement | High |
| Function | 6 trials (843 people) | No improvement | Moderate |
| Quality of life | 2 trials (269 people) | No improvement | High |