Surgical interventions for meniscal tears: a closer look at the evidence.
BACKGROUND
The aim of the present study was to compare the outcomes of various surgical treatments for meniscal injuries including (1) total and partial meniscectomy; (2) meniscectomy and meniscal repair; (3) meniscectomy and meniscal transplantation; (4) open and arthroscopic meniscectomy and (5) various different repair techniques.


METHODS
The Bone, Joint and Muscle Trauma Group Register, Cochrane Database, MEDLINE, EMBASE and CINAHL were searched for all (quasi) randomized controlled clinical trials comparing various surgical techniques for meniscal injuries. Primary outcomes of interest included patient-reported outcomes scores, return to pre-injury activity level, level of sports participation and persistence of pain using the visual analogue score. Where possible, data were pooled and a meta-analysis was performed.


RESULTS
A total of nine studies were included, involving a combined 904 subjects, 330 patients underwent a meniscal repair, 402 meniscectomy and 160 a collagen meniscal implant. The only surgical treatments that were compared in homogeneous fashion across more than one study were the arrow and inside-out technique, which showed no difference for re-tear or complication rate. Strong evidence-based recommendations regarding the other surgical treatments that were compared could not be made.


CONCLUSIONS
This meta-analysis illustrates the lack of level I evidence to guide the surgical management of meniscal tears.


METHODS
Level I meta-analysis.
Department of Orthopaedic Surgery, Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Eduard L A R
EL
Mutsaerts
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Kaufmann building suite 1011, Pittsburgh, PA, USA. vaneckcf@upmc.edu.
Carola F
http://orcid.org/0000-0002-6657-0001
CF
van Eck
Department of Orthopaedic Surgery, Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Victor A
VA
van de Graaf
Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Job N
JN
Doornberg
Department of Orthopaedic Surgery, Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Michel P J
MP
van den Bekerom
D001178:Arthroplasty / Q000379:methods*; D001182:Arthroscopy / Q000379:methods; D003094:Collagen; D016208:Databases, Factual; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008592:Menisci, Tibial / Q000601:surgery* / Q000637:transplantation; D010146:Pain; D019736:Prostheses and Implants; D000068958:Return to Sport; D000070600:Tibial Meniscus Injuries; D016896:Treatment Outcome; D014945:Wound Healing
D003094:Collagen
Clinical outcomes; Meniscal repair; Meniscal transplant; Meniscectomy; Meniscus; Meta-analysis