Meniscectomy & Nonoperative treatment in degenerative horizontal medial meniscus tears .
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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)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
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
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
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.
Quelle était la principale question de recherche ?
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)
De quoi dois-je me souvenir en priorité ?
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.
Comment cela affectera-t-il les soins prodigués à mes patients ?
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.
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