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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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 que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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