Arthroscopic Meniscectomy for Knee Osteoarthritis: the Gap Between Evidence Based Medicine and Expert Opinion

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Abstract

Background. For many decades arthroscopy considered to be the least invasive procedure among all surgical interventions for treatment of knee osteoarthritis (OA). In the beginning of XXI century several randomized clinical studies (RCS) demonstrated inefficiency of lavage and debridement for knee OA. The evidence regarding partial meniscectomy for this category of patients remained uncertain. Therefore the published clinical guidelines are either controversial or inconclusive.

The aim of this study was to critically review the current RCS and meta-analyses of RCS as well as actual clinical guidelines of international orthopedic societies and compare them to expert opinions.

Methods. We searched PubMed and eLIBRARY databases for high evidence research and analyzed the current clinical guidelines dedicated to partial meniscectomy for knee OA. Sixty orthopedic surgeons specialized in this field interviewed anonymously to clarify the decision making process in real clinical practice.

Results. More than patients with knee 2/3 OA of with degenerative meniscal tear benefit from non-surgical treatment therefore indication for arthroscopic partial meniscectomy is limited. The majority of current clinical guidelines consider surgery as an second option if conservative treatment failed and only for non-advanced knee OA. On the contrary experts interview demonstrated the lack of standardized approach as well as a lot of controversies in clinical decision making.

Conclusion. The future research dedicated to partial meniscectomy in knee OA should be appropriately designed to clearly differentiate the sub-population of patient who may benefit from arthroscopy in the long-term without carrying the risk of rapid disease progression with premature conversion to arthroplasty.

About the authors

Aleksandr V. Saraev

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: saraev@drkoleno.ru
ORCID iD: 0000-0002-9223-6330

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Nikolai N. Kornilov

Vreden National Medical Research Center of Traumatology and Orthopedics; Mechnikov North-Western State Medical University

Email: drkornilov@hotmail.com
ORCID iD: 0000-0001-6905-7900

Dr. Sci. (Med.)

Russian Federation, St. Petersburg; St. Petersburg

Taras A. Kuliaba

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: taraskuliaba@mail.ru
ORCID iD: 0000-0003-3175-4756

Dr. Sci. (Med.)

Russian Federation, St. Petersburg

Maxim I. Shubnyakov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: Drshubnyakov@gmail.com
ORCID iD: 0000-0002-4774-4272

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Aleksandr S. Demin

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: demin-medic@mail.ru
ORCID iD: 0000-0001-9415-0023
Russian Federation, St. Petersburg

Aleksey A. Stolyarov

Stavropol State University

Email: drstolyarov1@gmail.com
ORCID iD: 0000-0002-0301-8439

Cand. Sci. (Med.)

Russian Federation, Stavropol

Andrei P. Sereda

Vreden National Medical Research Center of Traumatology and Orthopedics; Academy of Postgraduate Education of Federal Medical Biological Agency

Email: drsereda@gmail.com
ORCID iD: 0000-0001-7500-9219

Dr. Sci. (Med.)

Russian Federation, St. Petersburg; Moscow

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2. Fig. 1. Exponential increase of publication in PubMed irrespective of research

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3. Fig. 2. Russian adaptation of recommendations from original paper of Siemieniuk et al. [2] with changes and additions of current authors

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4. Fig. 3. Distribution of the answers to the question 1: Is arthroscopy indicated in knee OA?

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5. Fig. 4. Distribution of the answers to the question 2: When arthroscopy is contraindicated in knee OA?

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6. Fig. 5. Distribution of the answers to the question 3: The clinical effect after arthroscopy in knee OA develops due to ...

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7. Fig. 6. Pain pathway after meniscus degenerative tear

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8. Fig. 7. Distribution of the answers to the question 4: If the patient with early OA demonstrates degenerative meniscus tear Stoller type III on MRI, then ...

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9. Fig. 8. Distribution of the answers to the question 5: After knee arthroscopy in OA patient the clinical effect continues...

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10. Fig. 9. Results of the vote to the question 6: Arthroscopy in knee OA may leads to development of...

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11. Fig. 10. Distribution of the answers to the question 7: What is the most important when you consider offering arthroscopy to patient with knee OA?

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