Clinical Question

Does arthroscopic surgery improve outcomes for patients with a degenerative meniscal tear and little or no osteoarthritis?

Bottom Line

Arthroscopic repair of degenerative meniscal tears in middle-aged adults does not significantly improve long-term pain or function. Patients should do physical therapy and try to avoid surgery if possible. (Level of Evidence = 1a –)

Synopsis

The authors of this systematic review identified randomized controlled trials that compared arthroscopic meniscal debridement with conservative management for patients with degenerative (nontraumatic) meniscal tears and little or no osteoarthritis. They found a total of seven studies (including five published in 2013) with a total of 805 patients, mostly from Europe. Overall study quality was not impressive. Conservative management generally included a standardized exercise program, although one study used an intra-articular steroid injection and one used sham surgery. Studies employed a variety of outcome measures, so the authors combined them using standardized mean differences for the effect sizes. The mean age of the patients was 53 to 59 years in the seven included studies. Risk of bias was high or uncertain for six of the seven studies, largely because of failure to mask and uncertainty regarding allocation concealment and randomization. In the short term (less than six months) there was a statistically significant improvement in functional outcomes with surgery (standardized mean difference = 0.25; 95% confidence interval, 0.02 to 0.48). However, this improvement was not seen for longer-term outcomes (six months to two years) and did not exceed the threshold for a minimally important difference. Surgery did not improve pain in the short term or in the long term.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Self-funded or unfunded

Reference: KhanMEvaniewNBediAAyeniORBhandariMArthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ2014;186(14):1057– 1064.