Authors' objectives:

On the basis of the available evidence the benefit of therapeutic arthroscopy in acute and chronic meniscus lesions of the knee joint with a stable ligament is to be assessed. Issues to be addressed are whether:

- arthroscopic surgery in acute and degenerative meniscus lesions contributes to an improved functional capacity of the knee joint

- patient or indication groups can be identified to be given special recommendations with regard to the effectiveness of arthroscopy.

Authors' results and conclusions: The publications analyzed within the framework of this report - a HTA publication by ANDEM (1995) and a Cochrane review by Howell and Handoll (1999) - in part pursue different questions and show marked differences with respect to utilization and the chosen methodical procedure. This is particularly true for the defined criteria for inclusion and exclusion, where in the English Cochrane review higher methodical demands are made on the underlying evidence. On the other hand, the French authors of ANDEM also include non-randomised studies. When formulating recommendations, in case of doubt we principally follow the English Cochrane publication's stricter conception. Questions which have been answered by reverting to weaker studies are merely reviewed as provisional summaries of the present state of knowledge. Fundamentally no recommendations based on randomised studies can be made concerning a comparison of efficacy between surgery and conservative treatment, arthroscopy and arthrotomy, as well as meniscus resection and refixation with respect to the functional capacity of the knee joint. Here only estimations based on methodically weaker studies and expert opinions are available. In accordance with this there are indications that a cautiously performed arthroscopic procedure is rather to be recommended, and that the arthroscopy compared to the arthrotomy holds a greater potential with respect to possibilities for limiting the extent of damage to the knee joint, for improving convalescence, for shortening the duration of surgery and for reducing bleeding, and that the meniscus refixation is a promising procedure, especially in verticle, traumatic (lateral) meniscus lesions with unstable ligaments which are longer than 1 cm (longitudinally) and situated in the vascular zone. Concerning the question as to whether the partial meniscectomy is to be preferred to the total meniscectomy, it can on the basis of two randomized studies be emphasized that the partial meniscectomy is associated with a shorter surgery duration, a more rapid convalescence, higher postoperative scores with respect to functional capacity and a better subjective estimation of the therapeutical result. Concerning the question about patient or indication groups where special recommendations with regard to the effectiveness of the arthroscopy can be given, only a few groups can be identified, likewise only on the basis of methodically weaker studies and expert estimations. In patients suffering from a ligament instability additionally to lesions of the medial or lateral meniscus the extent of the meniscectomy should be limited and a refixation be considered. Especially for patients with a history of degenerative meniscus lesions an arthroscopic treatment should only then be taken into account if a conservative or drug therapy has failed.

Authors' recommendations: The conclusions of the non-German HTA publications can in the authors' opinion be adopted as summaries of the present state of knowledge, with a reservation concerning the restricted strength of methodical evidence, since authors of German specialist publications on this topic also fall back upon international standards or study results. The existing deficits in research account for the established marked need for further research and information, particularly with respect to randomised controlled studies with long follow-up periods.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.dimdi.de/

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Germany

Organisation Name: German Agency for HTA at the German Institute for Medical Documentation and Information

Contact Address: German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information, Waisenhausgasse 36-38a, D-50676 Cologne Germany

Contact Name: dahta@dimdi.de

Contact Email: dahta@dimdi.de

Copyright: German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information