Posted by: Pulse Journal Club7 July 2015
A systematic review and meta-analysis of studies done until 2014 looking at those that investigated the benefits and harms of arthroscopy done for partial menisectomy, meniscal debridement, or both, in middle-aged or older patients.
RCTs were analysed for benefits of arthroscopy, and RCTs and cohort studies, case series, and cohort based studies were analysed for harms.
1 In the nine trials looking at the benefits of knee arthroscopy, the analysis determined that there was no benefit for physical function. There was a small benefit (effect size 0.14) of arthroscopy (vs control) for pain at three months and six months post-arthroscopy, but not after that (up to 24 months). This benefit (effect size 0.14) is similar to the benefit seen from paracetamol (effect size 0.14) and less than that seen with NSAIDs (effect size 0.29) when used for knee pain.
2 There were nine studies looking at the harms of knee arthroscopy identified, with harms including DVT, PE, the development of osteoarthritis, infection and death.
What this means for GPs
These findings do not support the use of knee arthroscopy in middle-aged or older patients.
The benefits of arthroscopic knee interventions for meniscal injury are very small and limited in time, while there are potentially serious risks.
Increasingly, GPs have direct access to advanced imaging such as ultrasound and MRI scans. As a result of this evidence, when meniscal injury is diagnosed as the cause of knee pain, the relatively small time-limited benefits of arthroscopy should be weighed against the risks of arthroscopy, and other non-surgical interventions (eg. painkillers, physiotherapy, and intra-articular injections) available in primary care.
In time this evidence may lead to a reduction in referrals to secondary care for knee arthroscopy for meniscal injury.
Dr Hamed Khan is a GP in the emergency department of St George’s, London, and a clinical lecturer. He tweets as @drhamedkhan.