title: Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis.
abstract: BACKGROUND
  Arthroscopic surgery for degenerative meniscal tears is a commonly performed procedure, yet the role of conservative treatment for these patients is unclear. This systematic review and meta-analysis evaluates the efficacy of arthroscopic meniscal débridement in patients with knee pain in the setting of mild or no concurrent osteoarthritis of the knee in comparison with nonoperative or sham treatments.
  
  
  METHODS
  We searched MEDLINE, Embase and the Cochrane databases for randomized controlled trials (RCTs) published from 1946 to Jan. 20, 2014. Two reviewers independently screened all titles and abstracts for eligibility. We assessed risk of bias for all included studies and pooled outcomes using a random-effects model. Outcomes (i.e., function and pain relief) were dichotomized to short-term (< 6 mo) and long-term (< 2 yr) data.
  
  
  RESULTS
  Seven RCTs (n = 805 patients) were included in this review. The pooled treatment effect of arthroscopic surgery did not show a significant or minimally important difference (MID) between treatment arms for long-term functional outcomes (standardized mean difference [SMD] 0.07, 95% confidence interval [CI] -0.10 to 0.23). Short-term functional outcomes between groups were significant but did not exceed the threshold for MID (SMD 0.25, 95% CI 0.02 to 0.48). Arthroscopic surgery did not result in a significant improvement in pain scores in the short term (mean difference [MD] 0.20, 95% CI -0.67 to 0.26) or in the long term (MD -0.06, 95% CI -0.28 to 0.15). Statistical heterogeneity was low to moderate for the outcomes.
  
  
  CONCLUSIONS
  There is moderate evidence to suggest that there is no benefit to arthroscopic meniscal débridement for degenerative meniscal tears in comparison with nonoperative or sham treatments in middle-aged patients with mild or no concomitant osteoarthritis. A trial of nonoperative management should be the first-line treatment for such patients.
authors.affiliation: Division of Orthopaedic Surgery (Khan, Evaniew, Ayeni, Bhandari), Department of Surgery, McMaster University, Hamilton, Ont.; MedSport, Department of Orthopaedic Surgery (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont. moinkhanmd@gmail.com.
authors.forename: Moin
authors.initials: M
authors.lastname: Khan
authors.affiliation: Division of Orthopaedic Surgery (Khan, Evaniew, Ayeni, Bhandari), Department of Surgery, McMaster University, Hamilton, Ont.; MedSport, Department of Orthopaedic Surgery (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
authors.forename: Nathan
authors.initials: N
authors.lastname: Evaniew
authors.affiliation: Division of Orthopaedic Surgery (Khan, Evaniew, Ayeni, Bhandari), Department of Surgery, McMaster University, Hamilton, Ont.; MedSport, Department of Orthopaedic Surgery (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
authors.affiliation: Division of Orthopaedic Surgery (Khan, Evaniew, Ayeni, Bhandari), Department of Surgery, McMaster University, Hamilton, Ont.; MedSport, Department of Orthopaedic Surgery (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
authors.affiliation: Division of Orthopaedic Surgery (Khan, Evaniew, Ayeni, Bhandari), Department of Surgery, McMaster University, Hamilton, Ont.; MedSport, Department of Orthopaedic Surgery (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D001182:Arthroscopy / Q000379:methods; D006801:Humans; D008592:Menisci, Tibial / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery; D000070600:Tibial Meniscus Injuries; D016896:Treatment Outcome