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2015 ; 112
(42
): 705-13
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The Treatment of Non-Traumatic Meniscus Lesions
#MMPMID26554420
Petersen W
; Achtnich A
; Lattermann C
; Kopf S
Dtsch Arztebl Int
2015[Oct]; 112
(42
): 705-13
PMID26554420
show ga
BACKGROUND: Most meniscus lesions are of non-traumatic origin. The indications
for partial meniscectomy are controversial. METHODS: We systematically searched
the literature for randomized controlled trials (RCTs) comparing partial
meniscectomy with non-surgical treatment. RESULTS: Of 6870 articles retrieved by
the literature search, we were able to include six in this systematic review.
Five trials showed no difference between the clinical outcomes of patients who
underwent arthroscopic partial meniscectomy and those who underwent control
treatment (arthroscopic lavage, physiotherapy, glucocorticoids). In three trials,
however, symptoms improved in 21-30% of the patients in the physiotherapy group
only after they underwent arthroscopic partial meniscectomy (crossover design).
In two trials, the percentage of patients who crossed over from one treatment arm
to the other was markedly lower; in one, the frequency of crossing over was not
reported. In one RCT, the patients who underwent arthroscopic partial
meniscectomy had significantly less pain and other symptoms. Five of the six
trials had acceptable scores for method, but all had weaknesses. These mainly
concerned the description of the surgical techniques and the failure to take
account of analgesic use-in particular, the use of non-steroidal antiinflammatory
drugs (NSAIDs). CONCLUSION: For most patients with non-traumatic meniscus
lesions, surgical and non-surgical treatments seem to be of equal value; only one
of the six included trials revealed lower pain and symptom scores after
arthroscopic partial meniscectomy. In multiple trials, however, the crossover
analysis showed that non-surgical treatment fails for some patients. These
patients may benefit from arthroscopic partial meniscectomy. Further trials are
needed to better define this subgroup of patients.
|*Physical Therapy Modalities
[MESH]
|Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use
[MESH]
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