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Review
Can we predict the clinical outcome of arthroscopic partial meniscectomy? A systematic review
  1. Susanne M Eijgenraam1,2,
  2. Max Reijman1,
  3. Sita M A Bierma-Zeinstra1,3,
  4. Daan T van Yperen1,
  5. Duncan E Meuffels1
  1. 1 Department of Orthopedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
  2. 2 Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
  3. 3 Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr Duncan E Meuffels, Department of Orthopedic Surgery, Erasmus MC, University Medical Centre Rotterdam, 3015 CE Rotterdam, Netherlands; d.meuffels{at}erasmusmc.nl

Abstract

NHS-Prospero registration number 42016048592

Objective In order to make a more evidence-based selection of patients who would benefit the most from arthroscopic partial meniscectomy (APM), knowledge of prognostic factors is essential. We conducted a systematic review of predictors for the clinical outcome following APM.

Design Systematic review

Data sources Medline, Embase, Cochrane Central Register, Web of Science, SPORTDiscus, PubMed Publisher, Google Scholar

Inclusion criteria Report an association between factor(s) and clinical outcome; validated questionnaire; follow-up >1 year.

Exclusion criteria <20 subjects; anterior cruciate ligament-deficient patients; discoid menisci; meniscus repair, transplantation or implants; total or open meniscectomy.

Methods One reviewer extracted the data, two reviewers assessed the risk of bias and performed a best-evidence synthesis.

Results Finally, 32 studies met the inclusion criteria. Moderate evidence was found, that the presence of radiological knee osteoarthritis at baseline and longer duration of symptoms (>1 year) are associated with worse clinical outcome following APM. In addition, resecting >50% of meniscal tissue and leaving a non-intact meniscal rim after meniscectomy are intra-articular predictive factors for worse clinical outcome. Moderate evidence was found that sex, onset of symptoms (acute or chronic), tear type or preoperative sport level are not predictors for clinical outcome. Conflicting evidence was found for the prognostic value of age, perioperative chondral damage, body mass index and leg alignment.

Summary/conclusion Long duration of symptoms (>1 year), radiological knee osteoarthritis and resecting >50% of meniscus are associated with a worse clinical outcome following APM. These prognostic factors should be considered in clinical decision making for patients with meniscal tears.

  • meniscectomy
  • meniscal injury
  • prognostic factors
  • systematic review

https://doi.org/10.1136/bjsports-2017-097836

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    Footnotes

    • Contributors SME, MR, SMAB-Z and DEM conceived and designed the study. SME, DTvY and DEM performed the literature search and selected the studies. SME collected the data from all included studies. Risk of bias was assessed by SME and MR. Study outcomes were summarised and analysed by SME, MR, SMAB-Z and DEM. SME wrote the initial draft of the manuscript, and MR, DTvY, SMAB-Z and DEM made significant revisions and contributions. All authors read and approved the final manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.