title: Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms.
abstract: OBJECTIVE
  To determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Pain and physical function.
  
  
  METHODS
  Systematic searches for benefits and harms were carried out in Medline, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2014. Only studies published in 2000 or later were included for harms.
  
  
  METHODS
  Randomised controlled trials assessing benefit of arthroscopic surgery involving partial meniscectomy, debridement, or both for patients with or without radiographic signs of osteoarthritis were included. For harms, cohort studies, register based studies, and case series were also allowed.
  
  
  RESULTS
  The search identified nine trials assessing the benefits of knee arthroscopic surgery in middle aged and older patients with knee pain and degenerative knee disease. The main analysis, combining the primary endpoints of the individual trials from three to 24 months postoperatively, showed a small difference in favour of interventions including arthroscopic surgery compared with control treatments for pain (effect size 0.14, 95% confidence interval 0.03 to 0.26). This difference corresponds to a benefit of 2.4 (95% confidence interval 0.4 to 4.3) mm on a 0-100 mm visual analogue scale. When analysed over time of follow-up, interventions including arthroscopy showed a small benefit of 3-5 mm for pain at three and six months but not later up to 24 months. No significant benefit on physical function was found (effect size 0.09, -0.05 to 0.24). Nine studies reporting on harms were identified. Harms included symptomatic deep venous thrombosis (4.13 (95% confidence interval 1.78 to 9.60) events per 1000 procedures), pulmonary embolism, infection, and death.
  
  
  CONCLUSIONS
  The small inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time and absent at one to two years after surgery. Knee arthroscopy is associated with harms. Taken together, these findings do not support the practise of arthroscopic surgery for middle aged or older patients with knee pain with or without signs of osteoarthritis.
  
  
  BACKGROUND
  PROSPERO CRD42014009145.
authors.affiliation: University of Southern Denmark, Department of Sports Science and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark.
authors.forename: J B
authors.initials: JB
authors.lastname: Thorlund
authors.affiliation: University of Southern Denmark, Department of Sports Science and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark Department of Orthopedics, Copenhagen University Hospital, Gentofte, Denmark.
authors.forename: C B
authors.initials: CB
authors.lastname: Juhl
authors.affiliation: University of Southern Denmark, Department of Sports Science and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark.
authors.forename: E M
authors.initials: EM
authors.lastname: Roos
authors.affiliation: University of Southern Denmark, Department of Sports Science and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark Department of Orthopedics, Clinical Sciences Lund, University of Lund, Sweden.
authors.forename: L S
authors.initials: LS
authors.lastname: Lohmander