Knee Surgery Not Necessary for Middle-Aged Patients with Mild Osteoarthritis

New meta-analysis evidence suggests that there is no benefit to having arthroscopic meniscal debridement for degenerative meniscal tears in comparison with nonoperative treatments or sham treatments in middle-aged patients with mild or no concomitant osteoarthritis. The findings were published August 25 online ahead of print in the Canadian Medical Association Journal.

“Doctors need to carefully weigh the costs and benefits when deciding who should undergo such surgery,” said Moin Khan, MD, lead author of the study and research fellow in orthopedic surgery in the Michael G. DeGroote School of Medicine at McMaster University in Hamilton, Ontario.

Dr. Khan and colleagues conducted a meta-analysis of 7 randomized controlled trials published between 1946 and January 20, 2014, on arthroscopic partial meniscectomy in patients with mild to no osteoarthritis compared with nonoperative treatments. Two reviewers independently screened all abstracts and titles for eligibility. In total, there were 811 knees in 805 patients with a mean age of 56 years. The pooled treatment effect of arthroscopic surgery did not show a significant or minimally important difference between treatment arms for long-term functional outcomes. Short-term functional outcomes between groups were significant but did not exceed the threshold for minimally important difference. Arthroscopic surgery did not result in a significant improvement in either short- or long-term pain scores.

“This study shows that surgery should not be the initial option for middle-age or older patients, as there is limited evidence supporting partial meniscectomy surgery for meniscus tears,” Dr. Khan said. “Other treatments should be used first.”

“Arthroscopic debridement or washout of knee osteoarthritis has come under lots of scrutiny based upon trials that suggest patients get no benefit from the procedure. We’re concerned that many surgeons worldwide may still be doing this procedure,” stated the researchers.

New meta-analysis evidence suggests that there is no benefit to having arthroscopic meniscal debridement for degenerative meniscal tears in comparison with nonoperative treatments or sham treatments in middle-aged patients with mild or no concomitant osteoarthritis. The findings were published August 25 online ahead of print in the Canadian Medical Association Journal.

“Doctors need to carefully weigh the costs and benefits when deciding who should undergo such surgery,” said Moin Khan, MD, lead author of the study and research fellow in orthopedic surgery in the Michael G. DeGroote School of Medicine at McMaster University in Hamilton, Ontario.

Dr. Khan and colleagues conducted a meta-analysis of 7 randomized controlled trials published between 1946 and January 20, 2014, on arthroscopic partial meniscectomy in patients with mild to no osteoarthritis compared with nonoperative treatments. Two reviewers independently screened all abstracts and titles for eligibility. In total, there were 811 knees in 805 patients with a mean age of 56 years. The pooled treatment effect of arthroscopic surgery did not show a significant or minimally important difference between treatment arms for long-term functional outcomes. Short-term functional outcomes between groups were significant but did not exceed the threshold for minimally important difference. Arthroscopic surgery did not result in a significant improvement in either short- or long-term pain scores.

“This study shows that surgery should not be the initial option for middle-age or older patients, as there is limited evidence supporting partial meniscectomy surgery for meniscus tears,” Dr. Khan said. “Other treatments should be used first.”

“Arthroscopic debridement or washout of knee osteoarthritis has come under lots of scrutiny based upon trials that suggest patients get no benefit from the procedure. We’re concerned that many surgeons worldwide may still be doing this procedure,” stated the researchers.

New meta-analysis evidence suggests that there is no benefit to having arthroscopic meniscal debridement for degenerative meniscal tears in comparison with nonoperative treatments or sham treatments in middle-aged patients with mild or no concomitant osteoarthritis. The findings were published August 25 online ahead of print in the Canadian Medical Association Journal.

“Doctors need to carefully weigh the costs and benefits when deciding who should undergo such surgery,” said Moin Khan, MD, lead author of the study and research fellow in orthopedic surgery in the Michael G. DeGroote School of Medicine at McMaster University in Hamilton, Ontario.

Dr. Khan and colleagues conducted a meta-analysis of 7 randomized controlled trials published between 1946 and January 20, 2014, on arthroscopic partial meniscectomy in patients with mild to no osteoarthritis compared with nonoperative treatments. Two reviewers independently screened all abstracts and titles for eligibility. In total, there were 811 knees in 805 patients with a mean age of 56 years. The pooled treatment effect of arthroscopic surgery did not show a significant or minimally important difference between treatment arms for long-term functional outcomes. Short-term functional outcomes between groups were significant but did not exceed the threshold for minimally important difference. Arthroscopic surgery did not result in a significant improvement in either short- or long-term pain scores.

“This study shows that surgery should not be the initial option for middle-age or older patients, as there is limited evidence supporting partial meniscectomy surgery for meniscus tears,” Dr. Khan said. “Other treatments should be used first.”

“Arthroscopic debridement or washout of knee osteoarthritis has come under lots of scrutiny based upon trials that suggest patients get no benefit from the procedure. We’re concerned that many surgeons worldwide may still be doing this procedure,” stated the researchers.