Knee arthroscopy is strongly
recommended against in almost all patients with degenerative knee disease,
a panel of international experts report in The BMJ. A systematic review
concluded it that does not, on average, result in a lasting improvement in
pain or function
ABSTRACT
Objective: To determine the
effects and complications of arthroscopic surgery compared with conservative
management strategies in patients with degenerative knee disease.
Design: Systematic review.
Main outcome measures: Pain,
function, adverseMevents.
Data sources: MEDLINE,
EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google
Scholar and Open Grey up to August 2016.
Eligibility criteria: For
effects, randomised clinical trials (RCTs) comparing arthroscopic surgery with
a conservative management strategy (including sham surgery) in patients with
degenerative knee disease. For complications, RCTs and observational studies.
Review methods: Two reviewers
independently extracted data and assessed risk of bias for patient-important
outcomes. A parallel guideline committee (BMJ Rapid Recommendations) provided
input on the design and interpretation of the systematic review, including
selection of patient-important outcomes. We used the GRADE approach to rate the
certainty (quality) of the evidence.
Results: We included 13 RCTs
and 12 observational studies. With respect to pain, the review identified
high-certainty evidence that knee arthroscopy results in a very small reduction
in pain up to 3 months (mean difference =5.4 on a 100-point scale, 95% CI 2.0
to 8.8) and very small or no pain reduction up to 2 years (mean difference
=3.1, 95% CI −0.2 to 6.4) when compared with conservative management. With
respect to function, the review identified moderate-certainty evidence that
knee arthroscopy results in a very small improvement in the short term (mean
difference =4.9 on a 100-point scale,
95% CI 1.5 to 8.4) and very
small or no improved function up to 2 years (mean difference =3.2, 95% CI −0.5
to 6.8). Alternative presentations of magnitude of effect, and associated
sensitivity
analyses, were consistent
with the findings of the primary analysis. Low-quality evidence suggested a
very low probability of serious complications after knee arthroscopy.
Conclusions: Over the long
term, patients who undergo knee arthroscopy versus those who receivE
conservative management strategies do not have important benefits in pain or
function.’/
Africa Center for Clin Gov
Research & Patient Safety
@ HRI West Africa Group - HRI WA
Consultants in Clinical Governance
Implementation
Publisher: Health and Medical
Journals
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Calabar
Cross River State, Nigeria
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