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Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2747 (Published 16 June 2015) Cite this as: BMJ 2015;350:h2747
  1. J B Thorlund, associate professor1,
  2. C B Juhl, assistant professor12,
  3. E M Roos, professor1,
  4. L S Lohmander, professor134
  1. 1University of Southern Denmark, Department of Sports Science and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
  2. 2Department of Orthopedics, Copenhagen University Hospital, Gentofte, Denmark
  3. 3Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark
  4. 4Department of Orthopedics, Clinical Sciences Lund, University of Lund, Sweden
  1. Correspondence to: J B Thorlund jthorlund{at}health.sdu.dk
  • Accepted 22 April 2015

Abstract

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.

Systematic review registration PROSPERO CRD42014009145.

Footnotes

  • We thank senior biostatistician and professor of clinical epidemiology Robin Christensen for his assistance with the statistical analysis.

  • Contributors: JBT, CBJ, EMR, and LSL all participated in the conception and design of the study. JBT, CBJ, and LSL were responsible for acquisition of data. CBJ did the analysis, and JBT, EMR, and LSL took part in the interpretation of the analysis. JBT and LSL drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version of the manuscript. LSL is the guarantor.

  • Funding: LSL is supported by the Swedish Research Council. The funder had no role in any part of the study or in any decision about publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: LSL has received personal fees from Össur, Flexion Therapeutics, Medivir, Teijin, MerckSerono, Allergan, and Galapagos and is editor-in-chief of Osteoarthritis and Cartilage; EMR has received personal fees for lectures and royalties for books from Össur, Finnish Orthopedic Society, Studentlitteratur, and Munksgaard and is an associate editor of Osteoarthritis and Cartilage; no other relationships or activities that may appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Transparency declaration: The lead author (JBT) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: Statistical code and dataset are available from the corresponding author.

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