Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta-analysis

Migliorini F, Schäfer L, Bell A, Weber CD, Vecchio G, Maffulli N · Knee Surgery, Sports Traumatology, Arthroscopy

Six studies reporting at a mean of 48.0 (SD 14.7) months found advanced knee osteoarthritis less frequent after repair, OR 0.51 (95% CI 0.39 to 0.69; P = 0.0001), with progression to knee arthroplasty reported at the same estimate from the same six studies. Mean joint space width did not separate (P = 0.09), nor did IKDC (P = 0.2), nor the rate of failures across nine studies at a mean of 63.0 (SD 24.7) months (P = 0.8). The resection group's Lysholm score was higher by a mean of 4.0 points (95% CI 0.52 to 7.49; P = 0.02), which the authors note does not reach the minimal clinically important difference.

Population

Twenty clinical studies comparing repair and resection of symptomatic meniscal tears, 31,783 patients, mean age 37.6 (SD 14.0), mean 12.1 months from injury to surgery

Intervention

Meniscal repair

Comparator

Meniscal resection

Limitations

Level III meta-analysis of non-randomised comparisons, so allocation to repair or resection was clinical judgement throughout, and the arms are of very different sizes — 6,514 repairs against 25,105 resections. The osteoarthritis result and the joint-space result point different ways, and the authors report both. The baseline table the authors read as comparable has 68% of the repair group and 53% of the resection group at osteoarthritis grade III-IV (P = 0.08), which is the imbalance most likely to move a radiographic endpoint. Progression to arthroplasty and advanced osteoarthritis are drawn from the same six studies and reported with the same odds ratio and interval.