Objective To determine benefits and harms of arthroscopic
knee surgery involving partial meniscectomy, debridement, or both for
middle aged or older patients with knee pain and degenerative knee
disease.
Design Systematic review and meta-analysis.
Main outcome measures Pain and physical function.
Data sources Systematic searches for benefits and harms
were carried out in Medline, Embase, CINAHL, Web of Science, and the
Cochrane Central Register of Controlled Trials (CENTRAL) up to August
2014. Only studies published in 2000 or later were included for harms.
Eligibility criteria for selecting studies Randomised
controlled trials assessing benefit of arthroscopic surgery involving
partial meniscectomy, debridement, or both for patients with or without
radiographic signs of osteoarthritis were included. For harms, cohort
studies, register based studies, and case series were also allowed.
Results The search identified nine trials assessing the
benefits of knee arthroscopic surgery in middle aged and older patients
with knee pain and degenerative knee disease. The main analysis,
combining the primary endpoints of the individual trials from three to
24 months postoperatively, showed a small difference in favour of
interventions including arthroscopic surgery compared with control
treatments for pain (effect size 0.14, 95% confidence interval 0.03 to
0.26). This difference corresponds to a benefit of 2.4 (95% confidence
interval 0.4 to 4.3) mm on a 0–100 mm visual analogue scale. When
analysed over time of follow-up, interventions including arthroscopy
showed a small benefit of 3–5 mm for pain at three and six months but
not later up to 24 months. No significant benefit on physical function
was found (effect size 0.09, −0.05 to 0.24). Nine studies reporting on
harms were identified. Harms included symptomatic deep venous thrombosis
(4.13 (95% confidence interval 1.78 to 9.60) events per 1000
procedures), pulmonary embolism, infection, and death.
Conclusions The small inconsequential benefit seen from
interventions that include arthroscopy for the degenerative knee is
limited in time and absent at one to two years after surgery. Knee
arthroscopy is associated with harms. Taken together, these findings do
not support the practise of arthroscopic surgery for middle aged or
older patients with knee pain with or without signs of osteoarthritis.
