BMJ Rapid Recommendation knee arthroscopy

Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline.

Siemieniuk RAC, Harris IA, Agoritsas T, et al. BMJ (Clinical research ed.) 2017 · PMID 28490431 · doi:10.1136/bmj.j1982

Question

Should patients with degenerative knee disease, including degenerative meniscal tears, be offered arthroscopic surgery?

Design

BMJ Rapid Recommendations GRADE-based clinical practice guideline informed by a linked systematic review of RCTs.

Patients

Adults with degenerative knee disease, with or without osteoarthritis, mechanical symptoms or a degenerative meniscal tear.

Intervention

Arthroscopic knee surgery (debridement or partial meniscectomy)

Comparison

Conservative management including exercise

Primary outcome

Pain and function at up to 2 years (patient-important outcomes)

Key result

The panel made a strong recommendation against arthroscopic surgery for almost all patients with degenerative knee disease, as any benefit was very small and short-lived.

Limitations

Strong recommendation applied broadly, including to patients with mechanical symptoms where trial evidence was more limited; criticised by some surgical bodies.

Impact on practice

Widely cited alongside NHS England evidence-based interventions policy to restrict arthroscopy for degenerate knees; true locked knees and acute traumatic tears remain separate indications.