Purpose
The purpose of this systematic review was to investigate study quality and risk of
bias for randomized trials comparing partial meniscectomy with physical therapy in
middle-aged patients with degenerative meniscus tears.
Methods
A systematic review of Medline, Embase, Scopus, and Google Scholar was performed from
1990 through 2017. The inclusion criteria were at least 1 validated outcome score,
and middle-aged patients (40 years and older) with a degenerative meniscus tear. Studies
with a sham arm, and acute and concomitant injuries were excluded. Risk of bias was
assessed with the Cochrane Risk of Bias Tool. The quality of studies was assessed
with the Cochrane GRADE tool and quality assessment tool (Effective Public Health
Practice Project). Publication bias was assessed by funnel plot and Egger’s test.
The I2 statistics was calculated a measure of statistical heterogeneity.
Results
Six studies were included, and all were assessed as having a high risk of bias. There
was no publication bias (P = .23). All studies were downgraded (low, n = 5; very low, n = 1). The Effective
Public Health Practice Project assessed 1 study as strong, 2 as moderate, and 3 as
weak. The overall results demonstrated moderate to low quality of the included studies.
The I2 statistic was 96.2%, demonstrating substantial heterogeneity between studies.
Conclusions
The results of this systematic review strongly suggest that there is currently no
compelling evidence to support arthroscopic partial meniscectomy versus physical therapy.
The studies evaluated here exhibited a high risk of bias, and the weak to moderate
quality of the available studies, the small sample sizes, and the diverse study characteristics
do not allow any meaningful conclusions to be drawn. Therefore, the validity of the
results and conclusions of prior systematic reviews and meta-analyses must be viewed
with extreme caution. The quality of the available published literature is not robust
enough at this time to support claims of superiority for either alternative, and both
arthroscopic partial meniscectomy or physical therapy could be considered reasonable
treatment options for this condition.
Level of evidence
Level II, systematic review of Level I and II studies.
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Article info
Publication history
Published online: July 20, 2018
Accepted:
April 24,
2018
Received:
September 5,
2017
Footnotes
See commentaries on pages 2709 and 2711
The authors report the following potential conflicts of interest or sources of funding: E.H. is an associate editor for Arthroscopy Journal. K.T. is a consultant for the AAOS. M.C. is an associate editor for Arthroscopy Journal. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Fresh Evidence That There Is Still No Reliable Evidence on How to Best Treat Knee Degenerative Meniscus TearsArthroscopyVol. 34Issue 9
- Editorial Commentary: Knee Meniscus and Hip Labrum: The Dilemma of Degenerative TearsArthroscopyVol. 34Issue 9
- PreviewThe dilemma for orthopaedic surgeons attempting to solve the problem of treating a knee meniscal tear in an older patient has always been whether or not a conservative approach is of value and if a surgical approach will provide benefit to the patient. Today, the same might be said of hip labral tears. Physical therapy is a wonderful tool to strengthen muscles, but it does not correct underlying pathology, which is often the source of joint pain. In an older patient with a symptomatic internal derangement, it is important for surgeons and payers to recognize that a simple outpatient surgical procedure often can improve that patient's symptoms.
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