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Arthroscopic meniscal surgery versus conservative management in patients aged 40 years and older: a meta-analysis

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The efficacy of arthroscopic meniscus surgery in old aged patients remains controversial. The purpose of the present study was to review published studies comparing arthroscopic meniscal surgery with conservative management to treat meniscal injuries in patients 40 years of age and older.

Materials and methods

Several electronic databases were queried for articles published until July 2017 that evaluated outcomes of arthroscopic meniscal surgery in patients aged 40 years and older. Data searches, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines, and the clinical outcomes were evaluated using various outcome values. The results are presented as the standard mean difference (SMD) for continuous outcomes with 95% confidence intervals (CIs).

Results

Nine randomized controlled trials (RCTs) were included. There were no significant differences in clinical outcomes such as relief in knee pain (SMD = 0.01, 95% CIs = − 0.15 to 0.18, I2 = 38%) and improved knee function (SMD = 0.01, 95% CIs = − 0.19 to 0.21, I2 = 57%) between arthroscopic meniscal surgery and conservative management for degenerative meniscal tears.

Conclusions

The efficacy of arthroscopic surgery was not superior to conservative management in this type of patients. Therefore, arthroscopic meniscal surgery should not be recommended as a first choice of treatment for degenerative meniscal tears. In patients over 40 years of age, arthroscopic surgery should be cautiously considered for degenerative meniscal tears and only when there has not been a satisfactory response to conservative management.

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References

  1. Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M et al (2017) Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 25:335–346

    PubMed  PubMed Central  Google Scholar 

  2. Xu C, Zhao J (2015) A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? Knee Surg Sports Traumatol Arthrosc 23:164–170

    PubMed  Google Scholar 

  3. Paxton ES, Stock MV, Brophy RH (2011) Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy 27:1275–1288

    PubMed  Google Scholar 

  4. Haviv B, Bronak S, Kosashvili Y, Thein R (2016) Arthroscopic meniscectomy of traumatic versus atraumatic tears in middle aged patients: is there a difference? Arch Orthop Trauma Surg 136:1297–1301

    PubMed  Google Scholar 

  5. Jevsevar DS, Yates AJ Jr, Sanders JO (2014) Arthroscopic partial meniscectomy for degenerative meniscal tear. N Engl J Med 370:1260. https://doi.org/10.1056/NEJMc1401128%23SA2

    Article  PubMed  Google Scholar 

  6. Krych AJ, Carey JL, Marx RG, Dahm DL, Sennett BJ, Stuart MJ et al (2014) Does arthroscopic knee surgery work? Arthroscopy 30:544–545

    PubMed  Google Scholar 

  7. Sadoghi P, Gomoll AH (2014) New England journal of medicine article evaluating the usefulness of meniscectomy is flawed. Arthroscopy 30:659–660

    PubMed  Google Scholar 

  8. Barrett GR, Field MH, Treacy SH, Ruff CG (1998) Clinical results of meniscus repair in patients 40 years and older. Arthroscopy 14:824–829

    CAS  PubMed  Google Scholar 

  9. Lyman S, Hidaka C, Valdez AS, Hetsroni I, Pan TJ, Do H et al (2013) Risk factors for meniscectomy after meniscal repair. Am J Sports Med 41:2772–2778

    PubMed  Google Scholar 

  10. Noyes FR, Barber-Westin SD (2000) Arthroscopic repair of meniscus tears extending into the avascular zone with or without anterior cruciate ligament reconstruction in patients 40 years of age and older. Arthroscopy 16:822–829

    CAS  PubMed  Google Scholar 

  11. Westermann RW, Wright RW, Spindler KP, Huston LJ, Group MK, Wolf BR (2014) Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. Am J Sports Med 42:2184–2192

    PubMed  PubMed Central  Google Scholar 

  12. Krych AJ, Pitts RT, Dajani KA, Stuart MJ, Levy BA, Dahm DL (2010) Surgical repair of meniscal tears with concomitant anterior cruciate ligament reconstruction in patients 18 years and younger. Am J Sports Med 38:976–982

    PubMed  Google Scholar 

  13. Snoeker BA, Bakker EW, Kegel CA, Lucas C (2013) Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sports Phys Ther 43:352–367

    PubMed  Google Scholar 

  14. Mesiha M, Zurakowski D, Soriano J, Nielson JH, Zarins B, Murray MM (2007) Pathologic characteristics of the torn human meniscus. Am J Sports Med 35:103–112

    PubMed  Google Scholar 

  15. Buchbinder R (2013) Meniscectomy in patients with knee osteoarthritis and a meniscal tear? N Engl J Med 368:1740–1741

    CAS  PubMed  Google Scholar 

  16. Carr A (2015) Arthroscopic surgery for degenerative knee. BMJ 350:h2983

    PubMed  Google Scholar 

  17. Thorlund JB, Juhl CB, Roos EM, Lohmander LS (2015) Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ 350:h2747

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Spahn G, Plettenberg H, Hoffmann M, Klemm HT, Brochhausen-Delius C, Hofmann GO (2017) The frequency of cartilage lesions in non-injured knees with symptomatic meniscus tears: results from an arthroscopic and NIR- (near-infrared) spectroscopic investigation. Arch Orthop Trauma Surg 137:837–844

    PubMed  Google Scholar 

  19. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713–721

    PubMed  Google Scholar 

  20. Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S (2007) Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 15:393–401

    PubMed  Google Scholar 

  21. Herrlin SV, Wange PO, Lapidus G, Hallander M, Werner S, Weidenhielm L (2013) Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc 21:358–364

    PubMed  Google Scholar 

  22. Gauffin H, Tagesson S, Meunier A, Magnusson H, Kvist J (2014) Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study. Osteoarthritis Cartilage 22:1808–1816

    CAS  PubMed  Google Scholar 

  23. Gauffin H, Sonesson S, Meunier A, Magnusson H, Kvist J (2017) Knee arthroscopic surgery in middle-aged patients with meniscal symptoms: a 3-year follow-up of a prospective, randomized study. Am J Sports Med 45:2077–2084

    PubMed  Google Scholar 

  24. Chang RW, Falconer J, Stulberg SD, Arnold WJ, Manheim LM, Dyer AR (1993) A randomized, controlled trial of arthroscopic surgery versus closed-needle joint lavage for patients with osteoarthritis of the knee. Arthritis Rheum 36:289–296

    CAS  PubMed  Google Scholar 

  25. Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ et al (2008) A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 359:1097–1107

    CAS  PubMed  Google Scholar 

  26. Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH et al (2002) A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 347:81–88

    PubMed  Google Scholar 

  27. Stensrud S, Risberg MA, Roos EM (2015) 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 94:460–473

    PubMed  Google Scholar 

  28. Vermesan D, Prejbeanu R, Laitin S, Damian G, Deleanu B, Abbinante A et al (2013) Arthroscopic debridement compared to intra-articular steroids in treating degenerative medial meniscal tears. Eur Rev Med Pharmacol Sci 17:3192–3196

    CAS  PubMed  Google Scholar 

  29. Yim JH, Seon JK, Song EK, Choi JI, Kim MC, Lee KB et al (2013) A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 41:1565–1570

    PubMed  Google Scholar 

  30. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL et al (2013) Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 368:1675–1684

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M (2014) Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ 186:1057–1064

    PubMed  PubMed Central  Google Scholar 

  32. Brignardello-Petersen R, Guyatt GH, Buchbinder R, Poolman RW, Schandelmaier S, Chang Y et al (2017) Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open 7:e016114

    PubMed  PubMed Central  Google Scholar 

  33. Monk P, Garfjeld Roberts P, Palmer AJ, Bayliss L, Mafi R, Beard D et al (2017) The Urgent Need for Evidence in Arthroscopic Meniscal Surgery. Am J Sports Med 45:965–973

    PubMed  Google Scholar 

  34. Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M et al (2008) Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 359:1108–1115

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Khan HI, Aitken D, Ding C, Blizzard L, Pelletier JP, Martel-Pelletier J et al (2016) Natural history and clinical significance of meniscal tears over 8 years in a midlife cohort. BMC Musculoskelet Disord 17:4

    PubMed  PubMed Central  Google Scholar 

  36. Biedert RM (2000) Treatment of intrasubstance meniscal lesions: a randomized prospective study of four different methods. Knee Surg Sports Traumatol Arthrosc 8:104–108

    CAS  PubMed  Google Scholar 

  37. Verdonk R, Madry H, Shabshin N, Dirisamer F, Peretti GM, Pujol N et al (2016) The role of meniscal tissue in joint protection in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1763–1774

    PubMed  Google Scholar 

  38. Hall M, Wrigley TV, Metcalf BR, Hinman RS, Cicuttini FM, Dempsey AR et al (2017) Knee biomechanics during jogging after arthroscopic partial meniscectomy: a longitudinal study. Am J Sports Med 45:1872–1880

    PubMed  Google Scholar 

  39. Spindler KP, McCarty EC, Warren TA, Devin C, Connor JT (2003) Prospective comparison of arthroscopic medial meniscal repair technique: inside-out suture versus entirely arthroscopic arrows. Am J Sports Med 31:929–934

    PubMed  Google Scholar 

  40. Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG et al (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27:346–354

    PubMed  Google Scholar 

  41. Lee DH, Lee BS, Kim JM, Yang KS, Cha EJ, Park JH et al (2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19:222–229

    PubMed  Google Scholar 

  42. Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30B:664–670

    CAS  PubMed  Google Scholar 

  43. Roos H, Lauren M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum 41:687–693

    CAS  PubMed  Google Scholar 

  44. Steadman JR, Matheny LM, Singleton SB, Johnson NS, Rodkey WG, Crespo B et al (2015) Meniscus suture repair: minimum 10-year outcomes in patients younger than 40 years compared with patients 40 and older. Am J Sports Med 43:2222–2227

    PubMed  Google Scholar 

  45. Higgins J, Green S (2008) Cochrane handbook for systematic reviews of interventions. Wiley, Hoboken (Version 5.1.0 of the Handbook)

    Google Scholar 

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Author information

Authors and Affiliations

  1. The Armed Forces Daegu Hospital, Daegu, Republic of Korea

    Dong-Yeong Lee

  2. Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Department of Orthopaedic Surgery, Jinju, Republic of Korea

    Young-Jin Park, Dae-Cheol Nam, Jin-Sung Park & Sang-Youn Song

  3. Department of Preventive Medicine, College of Medicine, Institute for Evidence-based Medicine, Korea University, Seoul, Republic of Korea

    Hyun-Jung Kim

  4. Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Samjeongja-ro 11, Seongsan-gu, Changwon, Republic of Korea

    Dong-Geun Kang

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Correspondence to Dong-Geun Kang.

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Because this study was a literature review, ethical approval was not obtained.

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Appendix 1 Electronic search strategy for each database (DOCX 17 KB)

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Lee, DY., Park, YJ., Kim, HJ. et al. Arthroscopic meniscal surgery versus conservative management in patients aged 40 years and older: a meta-analysis. Arch Orthop Trauma Surg 138, 1731–1739 (2018). https://doi.org/10.1007/s00402-018-2991-0

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  • DOI: https://doi.org/10.1007/s00402-018-2991-0

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