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Arthroscopic partial meniscectomy vs non-surgical or sham treatment in patients with MRI-confirmed degenerative meniscus tears : a systematic review and meta-analysis with individual participant data from 605 randomised patients

Wijn, S. R.W. ; Hannink, G. ; Østerås, H. ; Risberg, M. A. ; Roos, E. M. LU ; Hare, K. B. ; van de Graaf, V. A. ; Poolman, R. W. ; Ahn, H. W. and Seon, J. K. , et al. (2023) In Osteoarthritis and Cartilage 31(5). p.557-566
Abstract

Objective: To identify subgroups of patients with magnetic resonance imaging (MRI)-confirmed degenerative meniscus tears who may benefit from arthroscopic partial meniscectomy (APM) in comparison with non-surgical or sham treatment. Methods: Individual participant data (IPD) from four RCTs were pooled (605 patients, mean age: 55 (SD: 7.5), 52.4% female) as to investigate the effectiveness of APM in patients with MRI-confirmed degenerative meniscus tears compared to non-surgical or sham treatment. Primary outcomes were knee pain, overall knee function, and health-related quality of life, at 24 months follow-up (0–100). The IPD were analysed in a one- and two-stage meta-analyses. Identification of potential subgroups was performed by... (More)

Objective: To identify subgroups of patients with magnetic resonance imaging (MRI)-confirmed degenerative meniscus tears who may benefit from arthroscopic partial meniscectomy (APM) in comparison with non-surgical or sham treatment. Methods: Individual participant data (IPD) from four RCTs were pooled (605 patients, mean age: 55 (SD: 7.5), 52.4% female) as to investigate the effectiveness of APM in patients with MRI-confirmed degenerative meniscus tears compared to non-surgical or sham treatment. Primary outcomes were knee pain, overall knee function, and health-related quality of life, at 24 months follow-up (0–100). The IPD were analysed in a one- and two-stage meta-analyses. Identification of potential subgroups was performed by testing interaction effects of predefined patient characteristics (e.g., age, gender, mechanical symptoms) and APM for each outcome. Additionally, generalized linear mixed-model trees were used for subgroup detection. Results: The APM group showed a small improvement over the non-surgical or sham group on knee pain at 24 months follow-up (2.5 points (95% CI: 0.8–4.2) and 2.2 points (95% CI: 0.9–3.6), one- and two-stage analysis, respectively). Overall knee function and health-related quality of life did not differ between the two groups. Across all outcomes, no relevant subgroup of patients who benefitted from APM was detected. The generalized linear mixed-model trees did also not identify a subgroup. Conclusions: No relevant subgroup of patients was identified that benefitted from APM compared to non-surgical or sham treatment. Since we were not able to identify any subgroup that benefitted from APM, we recommend a restrained policy regarding meniscectomy in patients with degenerative meniscus tears.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Arthroscopic surgery, Individual participant data meta-analysis, IPDMA, Meniscectomy, Osteoarthritis, Sham treatment
in
Osteoarthritis and Cartilage
volume
31
issue
5
pages
557 - 566
publisher
Elsevier
external identifiers
  • scopus:85148750147
  • pmid:36646304
ISSN
1063-4584
DOI
10.1016/j.joca.2023.01.002
language
English
LU publication?
yes
id
8cf92d8d-2316-46af-a69d-6ea759a7c041
date added to LUP
2023-03-17 12:28:54
date last changed
2024-07-11 16:53:00
@article{8cf92d8d-2316-46af-a69d-6ea759a7c041,
  abstract     = {{<p>Objective: To identify subgroups of patients with magnetic resonance imaging (MRI)-confirmed degenerative meniscus tears who may benefit from arthroscopic partial meniscectomy (APM) in comparison with non-surgical or sham treatment. Methods: Individual participant data (IPD) from four RCTs were pooled (605 patients, mean age: 55 (SD: 7.5), 52.4% female) as to investigate the effectiveness of APM in patients with MRI-confirmed degenerative meniscus tears compared to non-surgical or sham treatment. Primary outcomes were knee pain, overall knee function, and health-related quality of life, at 24 months follow-up (0–100). The IPD were analysed in a one- and two-stage meta-analyses. Identification of potential subgroups was performed by testing interaction effects of predefined patient characteristics (e.g., age, gender, mechanical symptoms) and APM for each outcome. Additionally, generalized linear mixed-model trees were used for subgroup detection. Results: The APM group showed a small improvement over the non-surgical or sham group on knee pain at 24 months follow-up (2.5 points (95% CI: 0.8–4.2) and 2.2 points (95% CI: 0.9–3.6), one- and two-stage analysis, respectively). Overall knee function and health-related quality of life did not differ between the two groups. Across all outcomes, no relevant subgroup of patients who benefitted from APM was detected. The generalized linear mixed-model trees did also not identify a subgroup. Conclusions: No relevant subgroup of patients was identified that benefitted from APM compared to non-surgical or sham treatment. Since we were not able to identify any subgroup that benefitted from APM, we recommend a restrained policy regarding meniscectomy in patients with degenerative meniscus tears.</p>}},
  author       = {{Wijn, S. R.W. and Hannink, G. and Østerås, H. and Risberg, M. A. and Roos, E. M. and Hare, K. B. and van de Graaf, V. A. and Poolman, R. W. and Ahn, H. W. and Seon, J. K. and Englund, M. and Rovers, M. M.}},
  issn         = {{1063-4584}},
  keywords     = {{Arthroscopic surgery; Individual participant data meta-analysis; IPDMA; Meniscectomy; Osteoarthritis; Sham treatment}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{557--566}},
  publisher    = {{Elsevier}},
  series       = {{Osteoarthritis and Cartilage}},
  title        = {{Arthroscopic partial meniscectomy vs non-surgical or sham treatment in patients with MRI-confirmed degenerative meniscus tears : a systematic review and meta-analysis with individual participant data from 605 randomised patients}},
  url          = {{http://dx.doi.org/10.1016/j.joca.2023.01.002}},
  doi          = {{10.1016/j.joca.2023.01.002}},
  volume       = {{31}},
  year         = {{2023}},
}