Elsenosy Abdelfatah M, Elnewishy Ahmed, Delewar Radwa A
Trauma and Orthopaedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR.
Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, GBR.
Cureus. 2024 Nov 24;16(11):e74349. doi: 10.7759/cureus.74349. eCollection 2024 Nov.
Knee pain is a prevalent issue among older adults, often resulting from degenerative joint changes, and significantly impacts functionality and quality of life. While arthroscopic meniscal surgery is a common intervention for managing knee pain, its effectiveness compared to conservative treatments remains debated. This meta-analysis aims to compare the efficacy of arthroscopic meniscal surgery versus conservative management in alleviating knee pain and enhancing functional outcomes in patients with degenerative meniscal tears. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) sourced from PubMed, Web of Science, and Scopus. The focus was on studies evaluating knee pain and function in patients aged 40 and older. Primary outcomes included knee pain reduction, measured using scales such as the Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analog Scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and functional improvement, assessed by scores like the Knee Injury and Osteoarthritis Outcome Score for Activities of Daily Living (KOOS ADL) and Lysholm Knee Scoring Scale (Lysholm). A random-effects model was employed to account for variability across studies, with heterogeneity quantified using I². Nine RCTs, encompassing a total of 1,200 patients, met the inclusion criteria. Pain outcomes indicated similar improvements in both the arthroscopic surgery and conservative management groups. The pooled standardized mean difference (SMD) for pain was -0.01 (95% CI: -0.36 to 0.34). Functional outcomes also showed minimal differences between treatments, with an SMD of -0.04 (95% CI: -0.21 to 0.13). Moderate heterogeneity (I²=70%) was observed, attributed to variations in conservative management protocols and patient characteristics across studies. Arthroscopic meniscal surgery does not offer significant advantages over conservative management in reducing knee pain or improving function in patients with degenerative meniscal tears.
膝关节疼痛是老年人中普遍存在的问题，通常由关节退行性变引起，对功能和生活质量有显著影响。虽然关节镜下半月板手术是治疗膝关节疼痛的常见干预措施，但其与保守治疗相比的有效性仍存在争议。本荟萃分析旨在比较关节镜下半月板手术与保守治疗在缓解膝关节疼痛和改善退行性半月板撕裂患者功能结局方面的疗效。我们对来自PubMed、科学网和Scopus的随机对照试验（RCT）进行了系统评价和荟萃分析。重点是评估40岁及以上患者膝关节疼痛和功能的研究。主要结局包括使用膝关节损伤和骨关节炎结局评分（KOOS）、视觉模拟评分（VAS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）等量表测量的膝关节疼痛减轻情况，以及通过日常生活活动膝关节损伤和骨关节炎结局评分（KOOS ADL）和Lysholm膝关节评分量表（Lysholm）等评分评估的功能改善情况。采用随机效应模型来考虑研究间的变异性，使用I²对异质性进行量化。9项RCT共纳入1200例患者，符合纳入标准。疼痛结局表明，关节镜手术组和保守治疗组的改善情况相似。疼痛的合并标准化平均差（SMD）为-0.01（95%CI：-0.36至0.34）。治疗之间的功能结局也显示出最小差异，SMD为-0.04（95%CI：-0.21至0.13）。观察到中度异质性（I²=70%），这归因于各研究中保守治疗方案和患者特征的差异。在减轻膝关节疼痛或改善退行性半月板撕裂患者的功能方面，关节镜下半月板手术并不比保守治疗具有显著优势。
