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Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews
M Rotini1, G Papalia1, N Setaro1
1Department of Clinical and Molecular Science, School of Medicine, Università Politecnica Delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy.
Background:
Arthroscopic partial meniscectomy (APM) is widely applied for the treatment of degenerative meniscal lesions in middle-aged patients; however, such injury is often associated with mild or moderate osteoarthritis and has been reported by MRI in asymptomatic knees. Previous studies suggested, in most patients, a lack of benefit of surgical approach over conservative treatment, yet many controversies remain in clinical practice. Our aims were to assess the functional and pain scores between exercise therapy and arthroscopic surgery for degenerative meniscal lesions and to evaluate the methodological quality of the most recent systematic reviews (SRs).
Methods:
Two authors independently searched PubMed and Google Scholar for SRs comparing the outcome (in knee pain and functionality) of arthroscopic treatment and exercise therapy or placebo for degenerative meniscal lesions. The timeframe set was from 2009 to 2019 included.
Results:
A total of 13 SRs were selected. Two reviewers independently assessed the methodological quality of each paper using the AMSTAR 2 tool: seven scored as "moderate," four obtained a "low" grade while the remaining two were evaluated as "critically low." SRs agreed that in middle-aged patients with degenerative meniscal lesions arthroscopic surgery appears to grant no long-term improvement in pain and function over exercise therapy or placebo.
Conclusions:
Conservative treatment based on physical therapy should be the first-line management. However, most SRs revealed subgroups of patients that fail to improve after conservative treatment and find relief when undergoing surgery. In the future, randomized controlled trials, evidence should be looked for that APM can be successful in case of the unsatisfactory results after physical therapy.
Insights
For middle-aged patients with degenerative meniscal lesions, exercise therapy is recommended over arthroscopic partial meniscectomy (APM). Surgery offers no long-term benefits for pain or function compared to conservative treatments.
Area of Science:
- Orthopedics
- Sports Medicine
- Regenerative Medicine
Background:
- Degenerative meniscal lesions are common in middle-aged individuals, often co-occurring with osteoarthritis.
- Arthroscopic partial meniscectomy (APM) is a frequent surgical intervention, despite evidence suggesting limited benefits over conservative care.
- Clinical practice remains divided regarding the optimal treatment strategy for these lesions.
Purpose of the Study:
- To compare functional and pain outcomes between exercise therapy and arthroscopic surgery for degenerative meniscal lesions.
- To evaluate the methodological quality of recent systematic reviews (SRs) on this topic.
Main Methods:
- A systematic literature search was conducted on PubMed and Google Scholar for SRs published between 2009 and 2019.
- Two independent reviewers assessed the methodological quality of selected SRs using the AMSTAR 2 tool.
- Outcomes analyzed included knee pain and functional scores comparing arthroscopic treatment with exercise therapy or placebo.
Main Results:
- Thirteen SRs were included in the analysis.
- Methodological quality assessment revealed a majority of SRs with moderate (7) or low (4) quality, with two rated as critically low.
- The reviewed SRs concluded that APM provides no significant long-term improvement in pain or function compared to exercise therapy or placebo for middle-aged patients.
Conclusions:
- Physical therapy-based conservative treatment should be considered the primary management approach.
- Certain patient subgroups may not respond to conservative treatment and could benefit from surgical intervention.
- Further high-quality randomized controlled trials are needed to identify patients who may benefit from APM after conservative treatment failure.
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