title: The Urgent Need for Evidence in Arthroscopic Meniscal Surgery.
abstract: BACKGROUND
  Arthroscopic surgery of the knee is one of the most frequently performed orthopaedic procedures. One-third of these procedures are performed for meniscal injuries. It is essential that this commonly performed surgery be supported by robust evidence.
  
  
  OBJECTIVE
  To compare the effectiveness of arthroscopic surgery for meniscal injuries in all populations.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  An online search was conducted for randomized controlled trials (RCTs) and systematic reviews (SRs) that compared treatment options for meniscal injury. The following databases (inception to April 2015) were included in the search: CENTRAL; MEDLINE; EMBASE; NHS Evidence; National Guideline Clearing House, Database of Abstracts of Reviews of Effects, Health Technology Assessment; ISRCTN; Clinicaltrials.gov ; WHO trials platform. Only studies whose participants were selected on the basis of meniscal injury were included; no restrictions were placed on patient demographics. Two independent reviewers applied AMSTAR (A Measurement Tool to Assess Systematic Reviews) criteria for SRs and the Cochrane Collaboration risk-of-bias tool for RCTs.
  
  
  RESULTS
  Nine RCTs and 8 SRs were included in the review. No difference was found between arthroscopic meniscal debridement compared with nonoperative management as a first-line treatment strategy for patients with knee pain and a degenerative meniscal tear (mean difference: Knee injury and Osteoarthritis Outcome Score, 1.6 [95% CI, -2.2 to 5.2], pain visual analog scale, -0.06 [95% CI, -0.28 to 0.15]). Some evidence was found to indicate that patients with resistant mechanical symptoms who initially fail nonoperative management may benefit from meniscal debridement No studies compared meniscal repair with meniscectomy or nonoperative management. Initial evidence suggested that meniscal transplant might be favorable in certain patient groups.
  
  
  CONCLUSIONS
  Further evidence is required to determine which patient groups have good outcomes from each intervention. Given the current widespread use of arthroscopic meniscal surgeries, more research is urgently needed to support evidence-based practice in meniscal surgery in order to reduce the numbers of ineffective interventions and support potentially beneficial surgery.
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Monk
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Garfjeld Roberts
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Antony J R
authors.initials: AJ
authors.lastname: Palmer
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Bayliss
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Reza
authors.initials: R
authors.lastname: Mafi
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: David
authors.initials: D
authors.lastname: Beard
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Hopewell
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Price
mesh_terms: D000328:Adult; D001182:Arthroscopy; D057186:Comparative Effectiveness Research; D003646:Debridement; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000150:complications / Q000601:surgery*; D008297:Male; D020370:Osteoarthritis, Knee / Q000209:etiology; D000070600:Tibial Meniscus Injuries / Q000150:complications / Q000601:surgery*
keywords: arthroscopy; knee; meniscal tear; meniscus; systematic review