Clinic of Traumatology and Orthopaedic Surgery Eisenach, Sophienstr. 16, 99817 Eisenach, Germany.
Knee Surg Sports Traumatol Arthrosc. 2013 Jul;21(7):1553-61. doi: 10.1007/s00167-012-2169-1. Epub 2012 Aug 15.
Knee osteoarthritis is one of the most common orthopaedic diseases. Therapeutic options for this disease include conservative treatments and arthroscopic debridement and partial or complete replacement. This meta-analysis aimed to collect and analyse the available information on the effects of arthroscopic joint debridement related to the clinical outcomes, the required conversion to replacement and the factors for patient selection.
A search for publications was performed in the PubMed, Cochrane and EMBASE medical databases. The primary search resulted in a total of 1,512 citations. The results from 30 papers were included in this study. The extracted dates were listed in a standardised protocol. The statistical evaluation was performed using Comprehensive Meta-analysis software (V2 Biostat, Englewood, NJ, USA).
No randomised study that compared conservative and arthroscopic treatments for knee osteoarthritis was found. Most studies reported middle-term results after arthroscopic operations. The results of these studies showed excellent or good outcomes in more than 60 % of all patients. These results were correlated with a significant increase in the knee scores from baseline to follow-up; the standardised difference in means was 2.3 (CI 95 % 1.5-3.0, p < 0.001). The required conversion rate to replacement increased as the follow-up interval increased. The rates were as follows: 1 year-6.1 % (CI 95 %, 2.1-16.6 %), 2 years-16.8 % (CI 95 %, 10.2-26.3 %), 3 years-21.7 % (CI 95 %, 15.5-29.1 %) and 4 years-34.1 % (CI 95 %, 22.8-47.6 %). The mean survival time was 42.7 (CI 95 %, 14.5-71.1) months. Numerous factors influenced the outcome, including the radiological stage of the osteoarthritis and individual patient factors (e.g. time of history of osteoarthritis, weight and smoking). The local knee findings, such as axial dysalignment, missing effusion and massive crepitus, were also correlated with patient outcome.
Arthroscopic joint debridement is a potential and sufficient treatment for knee osteoarthritis in a middle-term time interval. This procedure results in an excellent or good outcome in approximately 60 % of patients in approximately 5 years.
Systematic review of studies, Level III.
膝骨关节炎是最常见的骨科疾病之一。该疾病的治疗选择包括保守治疗、关节镜下清创术以及部分或完全置换。本荟萃分析旨在收集和分析与临床结果、置换所需转换以及患者选择因素相关的关节镜下清创术的效果的现有信息。
在 PubMed、Cochrane 和 EMBASE 医学数据库中进行了文献检索。首次搜索共产生了 1512 条引文。30 篇论文的结果被纳入本研究。提取的数据列于标准化方案中。使用 Comprehensive Meta-analysis 软件（V2 Biostat，新泽西州恩格尔伍德）进行统计评估。
未发现比较膝骨关节炎保守治疗和关节镜治疗的随机研究。大多数研究报告了关节镜手术后的中期结果。这些研究的结果显示，超过 60%的患者获得了优秀或良好的结果。这些结果与膝关节评分从基线到随访的显著增加相关；均数标准化差值为 2.3（95%CI 1.5-3.0，p<0.001）。随着随访时间的延长，置换所需的转换率增加。比率如下：1 年-6.1%（95%CI 2.1-16.6%），2 年-16.8%（95%CI 10.2-26.3%），3 年-21.7%（95%CI 15.5-29.1%）和 4 年-34.1%（95%CI 22.8-47.6%）。平均生存时间为 42.7（95%CI 14.5-71.1）个月。许多因素影响结果，包括骨关节炎的放射学分期和个体患者因素（例如骨关节炎病史时间、体重和吸烟）。局部膝关节发现，如轴向失准、关节积液缺失和大量捻发音，也与患者的结果相关。
关节镜下关节清创术是一种有潜力的、在中期时间内治疗膝骨关节炎的方法。该方法在大约 5 年内，大约 60%的患者中获得了优秀或良好的结果。
系统评价研究，III 级。
