Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Medical Imaging, Nijmegen, the Netherlands.
Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Trondheim, Norway.
Osteoarthritis Cartilage. 2023 May;31(5):557-566. doi: 10.1016/j.joca.2023.01.002. Epub 2023 Jan 13.
To identify subgroups of patients with magnetic resonance imaging (MRI)-confirmed degenerative meniscus tears who may benefit from arthroscopic partial meniscectomy (APM) in comparison with non-surgical or sham treatment.
Individual participant data (IPD) from four RCTs were pooled (605 patients, mean age: 55 (SD: 7.5), 52.4% female) as to investigate the effectiveness of APM in patients with MRI-confirmed degenerative meniscus tears compared to non-surgical or sham treatment. Primary outcomes were knee pain, overall knee function, and health-related quality of life, at 24 months follow-up (0-100). The IPD were analysed in a one- and two-stage meta-analyses. Identification of potential subgroups was performed by testing interaction effects of predefined patient characteristics (e.g., age, gender, mechanical symptoms) and APM for each outcome. Additionally, generalized linear mixed-model trees were used for subgroup detection.
The APM group showed a small improvement over the non-surgical or sham group on knee pain at 24 months follow-up (2.5 points (95% CI: 0.8-4.2) and 2.2 points (95% CI: 0.9-3.6), one- and two-stage analysis, respectively). Overall knee function and health-related quality of life did not differ between the two groups. Across all outcomes, no relevant subgroup of patients who benefitted from APM was detected. The generalized linear mixed-model trees did also not identify a subgroup.
No relevant subgroup of patients was identified that benefitted from APM compared to non-surgical or sham treatment. Since we were not able to identify any subgroup that benefitted from APM, we recommend a restrained policy regarding meniscectomy in patients with degenerative meniscus tears.
确定磁共振成像（MRI）证实的退行性半月板撕裂患者亚组，这些患者可能从关节镜下部分半月板切除术（APM）中获益，与非手术或假手术治疗相比。
对四项 RCT 的个体参与者数据（IPD）进行了汇总（605 名患者，平均年龄：55（SD：7.5），52.4%为女性），以调查 MRI 证实的退行性半月板撕裂患者中 APM 的有效性与非手术或假手术治疗相比。主要结局为膝关节疼痛、总体膝关节功能和健康相关生活质量，随访 24 个月（0-100）。对 IPD 进行了单阶段和两阶段的荟萃分析。通过检验每个结局的预定患者特征（例如年龄、性别、机械症状）和 APM 的交互作用效果，确定潜在的亚组。此外，还使用广义线性混合模型树进行亚组检测。
APM 组在 24 个月随访时，膝关节疼痛的改善优于非手术或假手术组（2.5 分（95%CI：0.8-4.2）和 2.2 分（95%CI：0.9-3.6），单阶段和两阶段分析）。两组间总体膝关节功能和健康相关生活质量无差异。在所有结局中，均未发现 APM 获益的相关亚组患者。广义线性混合模型树也未发现亚组。
与非手术或假手术治疗相比，没有发现从 APM 中获益的相关亚组患者。由于我们未能确定任何从 APM 中获益的亚组，因此建议对退行性半月板撕裂患者采取保守的半月板切除术策略。
