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Can we predict the clinical outcome of arthroscopic partial meniscectomy? A systematic review
Susanne M Eijgenraam1,2, Max Reijman1, Sita M A Bierma-Zeinstra1,3
1Department of Orthopedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Nhs-Prospero Registration Number:
42016048592 OBJECTIVE: In order to make a more evidence-based selection of patients who would benefit the most from arthroscopic partial meniscectomy (APM), knowledge of prognostic factors is essential. We conducted a systematic review of predictors for the clinical outcome following APM.
Design:
Systematic review DATA SOURCES: Medline, Embase, Cochrane Central Register, Web of Science, SPORTDiscus, PubMed Publisher, Google Scholar INCLUSION CRITERIA: Report an association between factor(s) and clinical outcome; validated questionnaire; follow-up >1 year.
Exclusion Criteria:
<20 subjects; anterior cruciate ligament-deficient patients; discoid menisci; meniscus repair, transplantation or implants; total or open meniscectomy.
Methods:
One reviewer extracted the data, two reviewers assessed the risk of bias and performed a best-evidence synthesis.
Results:
Finally, 32 studies met the inclusion criteria. Moderate evidence was found, that the presence of radiological knee osteoarthritis at baseline and longer duration of symptoms (>1 year) are associated with worse clinical outcome following APM. In addition, resecting >50% of meniscal tissue and leaving a non-intact meniscal rim after meniscectomy are intra-articular predictive factors for worse clinical outcome. Moderate evidence was found that sex, onset of symptoms (acute or chronic), tear type or preoperative sport level are not predictors for clinical outcome. Conflicting evidence was found for the prognostic value of age, perioperative chondral damage, body mass index and leg alignment.
Summary/Conclusion:
Long duration of symptoms (>1 year), radiological knee osteoarthritis and resecting >50% of meniscus are associated with a worse clinical outcome following APM. These prognostic factors should be considered in clinical decision making for patients with meniscal tears.
Insights
Longer symptom duration, knee osteoarthritis, and extensive meniscus removal predict poorer outcomes after arthroscopic partial meniscectomy (APM). These factors are crucial for patient selection in APM procedures.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomedical Engineering
Background:
- Arthroscopic partial meniscectomy (APM) is a common procedure for meniscal tears.
- Identifying prognostic factors is essential for optimizing patient selection and outcomes.
- Predictors of clinical outcomes following APM require further investigation.
Purpose of the Study:
- To systematically review and synthesize evidence on predictors of clinical outcomes after APM.
- To identify factors associated with better or worse outcomes following arthroscopic partial meniscectomy.
- To inform evidence-based patient selection for APM.
Main Methods:
- Systematic review of multiple databases (Medline, Embase, Cochrane, Web of Science, SPORTDiscus, PubMed, Google Scholar).
- Inclusion criteria: studies reporting prognostic factors for APM outcomes with follow-up >1 year.
- Exclusion criteria: specific patient groups (e.g., ACL-deficient) and procedures (e.g., meniscus repair).
- Data extraction and risk of bias assessment by independent reviewers; best-evidence synthesis.
Main Results:
- Moderate evidence indicates that baseline knee osteoarthritis and symptom duration >1 year predict worse outcomes.
- Resecting >50% of meniscal tissue and non-intact meniscal rim are associated with poorer clinical outcomes.
- Sex, symptom onset, tear type, and preoperative sport level were not found to be predictors; evidence for age, BMI, and alignment was conflicting.
Conclusions:
- Longer symptom duration (>1 year), radiological knee osteoarthritis, and extensive meniscus resection (>50%) are associated with worse clinical outcomes after APM.
- These prognostic factors are important considerations for clinical decision-making in managing meniscal tears.
- Further research may clarify the prognostic value of other investigated factors.
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