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Subgroups of patients with osteoarthritis and medial meniscus tear or crystal arthropathy benefit from arthroscopic treatment

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to perform a systematic review of prospective randomized controlled trials comparing arthroscopic treatment for knee osteoarthritis (OA) with either other therapeutic interventions or sham treatment.

Methods

A systematic search for randomized controlled trials (RCT) about arthroscopic treatment (AT) for knee OA was performed according to the PRISMA guidelines. Arthroscopic treatment included procedures such as lavage, debridement and partial meniscectomy of the knee. Data source was PubMed central.

Results

Fourteen articles could be included. Five studies compared interventive AT with either sham surgery, lavage or diagnostic arthroscopy. Nine trials compared AT with another active intervention (exercise, steroid injection, hyaluronic acid injection). In ten trials, the clinical scores improved after arthroscopic treatment of knee OA in comparison to the baseline. In seven trials, there was a significant difference in the final clinical outcome with higher scores for patients after arthroscopic OA treatment in comparison to a control group. In four trials, the intention to treat analysis revealed no significant difference between arthroscopic OA treatment and the control group. In one of those trials, which compared arthroscopic partial meniscectomy (APM) with exercise, the cross over rate from exercise to AT was 34.9%. The clinical scores of cross-over patients improved after APM. In one study, the subgroup analysis revealed that patients with tears of the anterior two-thirds of the medial meniscus or any lateral meniscus tear had a higher probability of improvement after arthroscopic surgery than did patients with other intraarticular pathology. There was no difference in the side effects between patients with AT and the control group. Despite acceptable scores in the methodological quality assessment, significant flaws could be found in all studies. These flaws include bad description of the exact surgical technique or poor control of postoperative use of non-steroidal anti-inflammatory drugs (NSAID).

Conclusion

Results of RCTs comparing AT with other treatment options were heterogeneous. AT in OA patients is not useless because there is evidence that a subgroup of patients with non-traumatic flap tears of the medial meniscus or patients with crystal arthropathy benefit from arthroscopy. This topic has a high relevance because several health insurances do not reimburse arthroscopy for patients with OA anymore. The results of these randomized studies, however, should be interpreted with care because in many studies, the use of other therapeutic variables such as pain killers or NSAIDs was not controlled or reported.

Level of evidence

I.

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References

  1. Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90(9):1922–1923

    Article  PubMed  Google Scholar 

  2. Altman RD. Care (2010) Early management of osteoarthritis. Am J Manag 16(Suppl Management):41–47

    Google Scholar 

  3. Arden NK, Reading IC, Jordan KM, Thomas L, Platten H, Hassan A et al (2007) A randomised controlled trial of tidal irrigation vs corticosteroid injection in knee osteoarthritis: the KIVIS study. Osteoarthr Cartil 16(6):733–739

    Article  Google Scholar 

  4. Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M, Seil R (2017) Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 25(2):335–346

    Article  PubMed  PubMed Central  Google Scholar 

  5. Briggs KK, Kocher MS, Rodkey WG, Steadman JR (2006) Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am 88(4):698–705

    PubMed  Google Scholar 

  6. Buchbinder R, Richards B, Harris I (2014) Knee osteoarthritis and role for surgical intervention: lessons learned from randomized clinical trials and population-based cohorts. Curr Opin Rheumatol 26(2):138–144

    Article  PubMed  Google Scholar 

  7. Chang RW, Falconer J, Stulberg SD, Arnold WJ, Manheim LM, Dyer AR (1993) A randomized, controlled trial of arthroscopic surgery versus closed-needle joint lavage for patients with osteoarthritis of the knee. Arthritis Rheum 36(3):289–296

    Article  CAS  PubMed  Google Scholar 

  8. Cullen KA, Hall MJ, Golosinskiy A (2009) Ambulatory surgery in the United States, 2006. Natl Health Stat Rep 11:1–25

    Google Scholar 

  9. Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10(1):2–11

    Article  CAS  PubMed  Google Scholar 

  10. Englund M, Roos EM, Roos HP, Lohmander LS (2001) Patient-relevant outcomes fourteen years after meniscectomy: influence of type of meniscal tear and size of resection. Rheumatology 40(6):631–639

    Article  CAS  PubMed  Google Scholar 

  11. Englund M, Roemer FW, Hayashi D, Crema MD, Guermazi A. Meniscus pathology, osteoarthritis and the treatment controversy. Nat Rev Rheumatol. 8(7):412–419

  12. Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30B:664–670

    Article  CAS  PubMed  Google Scholar 

  13. Forkel P, Herbort M, Sprenker F, Metzlaff S, Raschke M, Petersen W (2014) The biomechanical effect of a lateral meniscus posterior root tear with and without damage to the meniscofemoral ligament: efficacy of different repair techniques. Arthroscopy 30(7):833–840

    Article  PubMed  Google Scholar 

  14. Forster MC, Straw R (2003) A prospective randomised trial comparing intra-articular Hyalgan injection and arthroscopic washout for knee osteoarthritis. Knee 10(3):291–293

    Article  CAS  PubMed  Google Scholar 

  15. Gauffin H, Tagesson S, Meunier A, Magnusson H, Kvist J (2014) Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study. Osteoarthr Cartil 22(11):1808–1816

    Article  CAS  PubMed  Google Scholar 

  16. van de Graaf VA, Wolterbeek N, Scholtes VA, Mutsaerts EL, Poolman RW (2014) Reliability and validity of the IKDC, KOOS, and WOMAC for patients with meniscal injuries. Am J Sports Med 11(6):1408–1416

    Article  Google Scholar 

  17. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 17(1):1–12

    Article  CAS  PubMed  Google Scholar 

  18. Johnson TC, Evans JA, Gilley JA, DeLee JC (2000) Osteonecrosis of the knee after arthroscopic surgery for meniscal tears and chondral lesions. Arthroscopy 16(3):254–261

    Article  CAS  PubMed  Google Scholar 

  19. Harris JD, Quatman CE, Manring MM, Siston RA, Flanigan DC (2014) How to write a systematic review. Am J Sports Med 42(11):2761–2768

    Article  PubMed  Google Scholar 

  20. Herrlin S, Hållander M, Wange P, Weidenhielm L, Werner S (2007) Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 15(4):393–401

    Article  PubMed  Google Scholar 

  21. Herrlin SV, Wange PO, Lapidus G, Hållander M, Werner S, Weidenhielm L (2013) Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc 21(2):358–364

    Article  PubMed  Google Scholar 

  22. Hubbard MJ (1996) Articular debridement versus washout for degeneration of the medial femoral condyle. A five-year study. J Bone Joint Surg Br 78(2):217–219

    Article  CAS  PubMed  Google Scholar 

  23. Kalunian KC, Moreland LW, Klashman DJ, Brion PH, Concoff AL, Myers S et al (2000) Visually-guided irrigation in patients with early knee osteoarthritis: a multicenter randomized, controlled trial. Osteoarthr Cartil 8(6):412–418

    Article  CAS  PubMed  Google Scholar 

  24. Katz JN, Chaisson CE, Cole B et al (2013) The MeTeOR trial (Meniscal Tear in Osteoarthritis Research): rationale and design features. Contemp Clin Trials 33:1189–1196

    Article  Google Scholar 

  25. Katz JN, Brophy RH, Chaisson CE et al (2013) Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 2;368(18):1675–1684

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Kijowski R, Woods MA, McGuine TA, Wilson JJ, Graf BK, De Smet AA (2011) Arthroscopic partial meniscectomy: MR imaging for prediction of outcome in middle-aged and elderly patients. Radiology 259(1):203–212

    Article  PubMed  Google Scholar 

  28. Kinsella SD, Carey JL (2013) Complications in brief: Arthroscopic partial meniscectomy. Clin Orthop Relat Res 471(5):1427–1432

    Article  PubMed  Google Scholar 

  29. Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ et al (2008) A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 359(11):1097–1107

    Article  CAS  PubMed  Google Scholar 

  30. Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM (2016) Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ 20(354):i3740

    Article  Google Scholar 

  31. Krogsgaard MR, Lind M, Jørgensen U (2014) A positive viewpoint regarding arthroscopy for degenerative knee conditions. Acta Orthop 85(6):681–682

    Article  PubMed  PubMed Central  Google Scholar 

  32. Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C (2008) Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev 1:CD005118

    Google Scholar 

  33. Lowe (2016) Editorial commentary: “There, it fits!” justifying nonsignificant P values. Arthroscopy 32:2318–2321

    Article  PubMed  Google Scholar 

  34. Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L (2012) Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20(3):401–406

    Article  PubMed  Google Scholar 

  35. Merchan EC, Galindo E (1993) Arthroscope-guided surgery versus nonoperative treatment for limited degenerative osteoarthritis of the femorotibial joint in patients over 50 years of age: a prospective comparative study. Arthroscopy 9(6):663–667

    Article  CAS  PubMed  Google Scholar 

  36. Moher D, Liberati A, Tetzlaff J, Altman DG (2010) The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA STATement. PLoS Med 6(7):e1000097

    Article  Google Scholar 

  37. Molnar S, Grouven U, Hermanns T, Janßen I, Sauerland S (2014) Arthroscopy of the Knee Joint for Gonarthrosis. Institute for Quality and Efficiency in Health Care. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG). Final report No. N11-01 Version 1.0

  38. Moseley JB Jr, Wray NP, Kuykendall D, Willis K, Landon G (1996) Arthroscopic treatment of osteoarthritis of the knee: a prospective, randomized, placebo-controlled trial; results of a pilot study. Am J Sports Med 24(1):28–34

    Article  PubMed  Google Scholar 

  39. Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH et al (2002) A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 347(2):81–88

    Article  PubMed  Google Scholar 

  40. Petersen W, Tillmann B (1998) Collagenous fibril texture of the human knee joint menisci. Anat Embryol (Berl) 197(4):317–324

    Article  CAS  Google Scholar 

  41. Petersen W, Forkel P, Feucht MJ, Zantop T, Imhoff AB, Brucker PU (2014) Posterior root tear of the medial and lateral meniscus. Arch Orthop Trauma Surg 134(2):237–255

    Article  PubMed  Google Scholar 

  42. Petersen W, Achtnich A, Lattermann C, Kopf S (2015) The treatment of non-traumatic meniscus lesions. Dtsch Arztebl Int 16(42):705–713

    Google Scholar 

  43. Robert Koch-Institut (2011) Daten und Fakten: Ergebnisse der Studie »Gesundheit in Deutschland aktuell 2009«. RKI, Berlin

    Google Scholar 

  44. Roos H, Laurén M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum 41:687–693

    Article  CAS  PubMed  Google Scholar 

  45. Scheiman JM (2016) NSAID-induced gastrointestinal injury: a focused update for clinicians. J Clin Gastroenterol 50(1):5–10

    Article  CAS  PubMed  Google Scholar 

  46. Sihvonen R, Järvelä T, Aho H, Järvinen TL (2012) Validation of the Western Ontario Meniscal Evaluation Tool (WOMET) for patients with a degenerative meniscal tear: a meniscal pathology-specific quality-of-life index. J Bone Joint Surg Am 16(10):e65–e94

    Article  Google Scholar 

  47. Sihvonen R, Paavola M, Malmivaara A, Järvinen TL (2013) Finnish Degenerative Meniscal Lesion Study (FIDELITY): a protocol for a randomised, placebo surgery controlled trial on the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscus injury with a novel ‘RCT within-a-cohort’ study design. BMJ Open 3(3):e002510

    Article  PubMed  PubMed Central  Google Scholar 

  48. Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL (2013) Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. N Engl J Med 369(26):2515–2524

    Article  CAS  PubMed  Google Scholar 

  49. Sihvonen R, Englund M, Turkiewicz A, Järvinen TL (2016) Mechanical symptoms as an indication for knee arthroscopy in patients with degenerative meniscus tear: a prospective cohort study. Osteoarthr Cartil 24(8):1367–1375

    Article  CAS  PubMed  Google Scholar 

  50. Thorlund JB, Hare KB, Lohmander LS (2014) Large increase in arthroscopic meniscus surgery in the middle-aged and older population in Denmark from 2000 to 2011. Acta Orthop 85(3):287–292

    Article  PubMed  PubMed Central  Google Scholar 

  51. Yim JH, Seon JK, Song EK, Choi JI, Kim MC, Lee KB, Seo HY (2013) A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 41(7):1565–1570

    Article  PubMed  Google Scholar 

  52. PROSPERO International prospective register of systematic reviews, National Institute for Health Research. http://www.crd.york.ac.uk/PROSPERO

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Funding

The study was funded by Martin Luther Hospital, Berlin Germany.

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Authors and Affiliations

  1. Martin Luther Krankenhaus, Caspar Theyß Str. 27-31, 14193, Berlin, Germany

    Katrin Karpinski & Wolf Petersen

  2. Orthopädische Gemeinschaftspraxis Neuss, Neuss, Germany

    Ralf Müller-Rath

  3. OCM, Munich, Germany

    Phillipp Niemeyer

  4. Sporthopädicum, Straubing, Germany

    Peter Angele

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  1. Katrin Karpinski
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  2. Ralf Müller-Rath
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  4. Peter Angele
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  5. Wolf Petersen
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Correspondence to Wolf Petersen.

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Karpinski, K., Müller-Rath, R., Niemeyer, P. et al. Subgroups of patients with osteoarthritis and medial meniscus tear or crystal arthropathy benefit from arthroscopic treatment. Knee Surg Sports Traumatol Arthrosc 27, 782–796 (2019). https://doi.org/10.1007/s00167-018-5086-0

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