Meniscectomy & Nonoperative treatment in degenerative horizontal medial meniscus tears .
تم تحديد هذه الدراسة على أنها ذات تأثير كبير محتمل.
يُقدّر مقياس التأثير العالي الذي يعتمد على الذكاء الاصطناعي من OE التأثير المحتمل لورقة بحثية ما من خلال دمج الإشارات من كل من المجلة التي نُشرت فيها والمحتوى العلمي للمقالة نفسها.
تم تطوير نموذج OE High Impact باستخدام أحدث تقنيات معالجة اللغة الطبيعية، ويتنبأ نموذج OE High Impact بدقة أكبر بأداء الاقتباس المستقبلي للدراسة أكثر من معامل تأثير المجلة وحده.
وهذا يتيح التعرف المبكر على الأبحاث ذات المغزى السريري ويساعد القراء على التركيز على المقالات التي من المرجح أن تشكل الممارسة المستقبلية.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(15):15 Am J Sports Med. 2013 Jul;41(7):1565-70. doi: 10.1177/0363546513488518. Epub 2013 May 23One hundred and eight patients with knee pain and a degenerative horizontal tear of the posterior horn of the medial meniscus were randomized to be treated either with arthroscopic meniscectomy or conservative treatment (strength training). The aim of the trial was to evaluate if the surgical procedure provided superior clinical outcomes, measured by Visual Analog Scale (VAS) pain, Lysholm knee score, Tegner activity scale, patient subjective knee pain and satisfaction. After 2 years of evaluation, the treatments did not differ in terms of keen pain relief, knee function, or satisfaction.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
نعم = 1
غير مؤكد = 0.5
غير ذي صلة = 0
لا = 0
يقيّم تقييم معايير الإبلاغ الشفافية التي يبلغ بها المؤلفون عن الخصائص المنهجية والتجريبية للتجربة في المنشور. ينقسم التقييم إلى خمس فئات معروضة أدناه.
3/4
Randomization
3/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
مؤشر الهشاشة هو أداة تساعد في تفسير النتائج المهمة، وتوفر مقياسًا لقوة النتيجة. ويمثل مؤشر الهشاشة عدد الأحداث المتتالية التي يجب إضافتها إلى نتيجة ثنائية التفرع لجعل النتيجة غير مهمة. يمثل الرقم الصغير نتيجة أضعف ويمثل الرقم الكبير نتيجة أقوى.
لماذا كانت هناك حاجة لهذه الدراسة الآن؟
Horizontal tears of the meniscus often occur in a middle aged population due to degenerative changes. Surgical treatments have proven to be difficult and propose an increased risk of osteoarthritis. Little is currently know about the comparative efficacy of operative treatment and non-operative management due a lack of previous studies. Hence, this RCT aimed to compare the clinical outcomes of arthroscopic meniscectomy with nonoperative treatment for degenerative horizontal tears in the posterior horn of the medial meniscus.
ما هو سؤال البحث الرئيسي؟
Will the 2 year postoperative clinical outcomes of arthroscopic meniscectomy be comparable to nonoperative treatment for degenerative horizontal tears of the medial meniscus?
- The most common symptoms reported by patients before treatments were knee pain at high flexion (92%) and tenderness at the posteromedial joint line (84%).
- The meniscectomy group and non-operative group demonstrated similar VAS scores at 2 year follow up (Meniscectomy: 1.8 (range 1-5); Nonoperative group: 1.7 (range 1-4) (P = 0.675). The surgical treatment group experienced improvement 6 months after the procedure, while symptoms lasted longer in non-operative group.
- The meniscectomy group had knee pain with mechanical symptoms completely relieved in 34 patients, improved in 13, and remained in 3 at 2 year follow up. In the nonoperative group, knee pain was completely relieved in 35, improved in 12, and remained in 5 patients. No statistical differences were observed between the treatments (P = 0.652).
- The nonoperative treatment had 17 patients very satisfied, 29 satisfied and 6 dissatisfied, while meniscectomy group had 18 very satisfied, 28 satisfied, and 4 dissatisfied (P = 0.357 between groups)
- Lysholm scores improved in both groups, average scores of 83.2 (range, 52-100) in meniscectomy group and 84.3 (range, 58-100) in nonoperative groups at 2 years (P = 0.237). The only difference, favoring meniscectomy, was seen at 3 months (P = 0.031)
- Tegner scores improved at 2 years from 4.2 (range, 0-6) to 5.1 (range, 0-8) in the meniscectomy group and from 4.1 (range, 0-6) to 4.9 (range, 0-8) in the nonoperative group. No differences were found between the treatments (P = 0.522).
- OA progression by >1 grade was seen in 2 patients in meniscetomy group (ages 59 to 62 years) and 3 in the nonoperative group (ages 57, 67, and 74 years) at 2 years. The difference compared to pre-treatment was not significant (both p>0.05)
ما الذي يجب أن أتذكره أكثر؟
In the treatment of horizontal tears of the posterior horn of the medial meniscus of the knee joint, meniscectomy and nonoperative management both indicated similar knee pain relief, improved knee function, and increased patient satisfaction at 2 years.
كيف سيؤثر ذلك على رعاية مرضاي؟
The study suggested that non-operative treatment with exercises and analgesics provides similar clinical results as surgical treatment. Similar trials still need to be conducted to replicate results before definitive conclusion can be made. Additionally, complications should be reported in detail and a cost effectiveness assessment should be considered in the future.
تنويه
هذا المحتوى الموجود في هذه الصفحة هو لأغراض إعلامية فقط وليس الغرض منه أن يكون بديلاً عن المشورة الطبية المتخصصة أو التشخيص أو العلاج. إذا كنت بحاجة إلى علاج طبي، اطلب دائمًا مشورة طبيبك أو اذهب إلى أقرب قسم طوارئ إليك. الآراء والمعتقدات ووجهات النظر التي يعبر عنها الأفراد في المحتوى الموجود في هذه الصفحة لا تعكس آراء ومعتقدات ووجهات نظر أورثوإيفيدنس.
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