Authors' objectives: To determine time to total knee arthroplasty and rates in patients with meniscal injury receiving partial meniscectomy compared to those treated conservatively.

Authors' results and conclusions: 121 published studies were identified from the literature searches. Upon examination of the titles and abstracts of these 121 studies, 21 studies were retrieved in full for further appraisals. Four further studies were also retrieved in full as the results of the manual searches. Hence, overall, there were 25 published studies retrieved in full in this systematic review. Of the 25 studies that were retrieved in full, 14 studies did not provide relevant data or were not relevant to the objective of this systematic review and will not be discussed further, 11 of the remaining studies will be reviewed. Smith et al reported the impact of meniscectomy among those with a meniscal tear on total knee arthroplasty (TKA) outcomes. This study, which was essentially a large case series (level of evidence 4), identified 2904 patients, representing 5.2% of the analyzed cohort who underwent arthroscopic procedures on which TKA was ultimately performed in an average of 7.2±3.0 months post meniscectomy. This study was published as an abstract only, no further information was available. A large (n total 3638), administrative database-based, comparative study, level of evidence 3. However, for our objective we should consider this study as a large (n=3520) case series of patients with partial meniscectomy (ME), and categorized this as level 4 evidence, investigating the conversion rate to unicompartmental or total knee arthroplasty (KA) in patients ? 40 years at time of initial surgery after partial meniscectomy (ME) or meniscal repair (MR) was reported by Runer et al98. The authors reported that out of all patients (n=3638), a total of 273 (7.5%) underwent subsequent KA. In those patients undergoing primary ME, conversion to KA (n = 270, 7.7%) was significantly higher compared to those undergoing primary MR (n = 3 (2.5%); OR: 3.2, 95% CI: 1.0–10.1, p = 0.03). The time from primary surgery to KA (ME: 22 ± 17 months, MR: 25 ± 15 months, p = 0.95) did not differ between both treatment groups. A Cochrane based systematic review (level of evidence 1), investigating the benefits and harms of arthroscopic surgery, including debridement, partial meniscectomy, or both, compared with placebo surgery or non-surgical treatment in patients with degenerative knee disease (osteoarthritis, degenerative meniscal tears, or both), was reported by O’Connor et al1 . Sixteen trials (2105 participants) met the inclusion criteria. The average age of participants ranged from 46 to 65 years, and 56% of participants were women. Four trials (380 participants) compared arthroscopic surgery to placebo surgery and the remaining trials, arthroscopic surgery was compared to exercise (eight trials, 1371 participants), a single intra-articular glucocorticoid injection (one trial, 120 participants), non-arthroscopic lavage (one trial, 34 participants), non-steroidal anti-inflammatory drugs (one trial, 80 participants) and weekly hyaluronic acid injections for five weeks (one trial, 120 participants). Subsequent knee surgery (replacement or high tibial osteotomy) was reported in two out of 100 people in the conservative groups and four out of 100 people in the arthroscopy surgery groups at up to five years in four trials (RR 2.63, 95% CI 0.94 to 7.34; I2 = 11%; 4 trials, 864 participants). The authors further concluded that whether arthroscopic surgery resulted in slightly more subsequent knee surgery (replacement or osteotomy) compared to control remains unresolved (literature search up to April 16, 2021). In summary of studies found in this review, it was highlighted that significant heterogeneity, between studies, with regard to conversion to TKA between conservative vs. partial meniscectomy treated patients with meniscal injury. Among those with meniscal injury treated conservatively, the range of conversion to TKA ranged from 2% to 34.6% with the mean time to conversion between 19 to 60 months. Alternatively, those treated with partial meniscectomy, between 4% to 54% were reported to converted to TKA with the mean time to conversion between 12 to 84 months. We observed heterogeneity, regarding study design (level of evidence), demographics of the participants, underlying disease severity as well as conservative treatment modalities that may affect the reported outcomes. However, it should be noted that the only randomized controlled trial included in this systematic review concluded that TKA occurred more often in those who underwent APM than in those that undertook conservative treatment.

Authors' methods: A comprehensive and systematic literature search was conducted on March 13, 2025. The search was done on commercial medical literature databases. A combination of keywords was employed in this search. No limitation, such as on the language and time of publication, was implemented in any of these searches. A manual search was also done on the references of the articles that were retrieved in full.

Project Status: Completed

URL for project: https://www.worksafebc.com/en/about-us/research-services/evidence-based-medicine-and-systematic-reviews

Year Published: 2025

URL for published report: https://www.worksafebc.com/en/resources/health-care-providers/guides/meniscal-injury-and-time-to-tka?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fforms-resources%23sort%3DDate%26q%3DMeniscal%2520Injury%2520and%2520Time%2520to%2520TKA%253A%2520Partial%2520Meniscectomy%2520vs.%2520Conservative%2520Treatment%26f%3Alanguage-facet%3D%5BEnglish%5D%26tags%3DGuide%7C2d7eb4b30f6a4a319e0d40565c9abbab%2CHealth%2520Care%2520Provider%7C13468b0b3f074f6bade3f57ac3cdfb8e%2CSystematic%2520Review%7Cf78c29d570c14ec3b5a394385905df70&highlight=Meniscal%20Injury%20and%20Time%20to%20TKA:%20Partial%20Meniscectomy%20vs.%20Conservative%20Treatment

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: WorkSafeBC

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