Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review
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ObjectiveTo determine the effects and complications of arthroscopic surgery compared with conservative management strategies in patients with degenerative knee disease.DesignSystematic review.Main outcome measuresPain, function, adverse events.Data sourcesMEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and Open Grey up to August 2016.Eligibility criteriaFor effects, randomised clinical trials (RCTs) comparing arthroscopic surgery with a conservative management strategy (including sham surgery) in patients with degenerative knee disease. For complications, RCTs and observational studies.Review methodsTwo reviewers independently extracted data and assessed risk of bias for patient-important outcomes. A parallel guideline committee (BMJRapid Recommendations) provided input on the design and interpretation of the systematic review, including selection of patient-important outcomes. We used the GRADE approach to rate the certainty (quality) of the evidence.ResultsWe included 13 RCTs and 12 observational studies. With respect to pain, the review identified high-certainty evidence that knee arthroscopy results in a very small reduction in pain up to 3 months (mean difference =5.4 on a 100-point scale, 95% CI 2.0 to 8.8) and very small or no pain reduction up to 2 years (mean difference =3.1, 95% CI −0.2 to 6.4) when compared with conservative management. With respect to function, the review identified moderate-certainty evidence that knee arthroscopy results in a very small improvement in the short term (mean difference =4.9 on a 100-point scale, 95% CI 1.5 to 8.4) and very small or no improved function up to 2 years (mean difference =3.2, 95% CI −0.5 to 6.8). Alternative presentations of magnitude of effect, and associated sensitivity analyses, were consistent with the findings of the primary analysis. Low-quality evidence suggested a very low probability of serious complications after knee arthroscopy.ConclusionsOver the long term, patients who undergo knee arthroscopy versus those who receive conservative management strategies do not have important benefits in pain or function.Trial registration numberPROSPERO CRD42016046242.
