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Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline
  1. Reed A C Siemieniuk1,2,
  2. Ian A Harris3,4,
  3. Thomas Agoritsas1,5,
  4. Rudolf W Poolman6,
  5. Romina Brignardello-Petersen1,7,
  6. Stijn Van de Velde8,
  7. Rachelle Buchbinder9,10,
  8. Martin Englund11,
  9. Lyubov Lytvyn12,
  10. Casey Quinlan13,
  11. Lise Helsingen14,
  12. Gunnar Knutsen15,
  13. Nina Rydland Olsen16,
  14. Helen Macdonald17,
  15. Louise Hailey18,
  16. Hazel M Wilson19,
  17. Anne Lydiatt20,
  18. Annette Kristiansen21,22
  1. 1 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  2. 2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3 Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia
  4. 4 South Western Sydney Clinical School, UNSW, Australia
  5. 5 Division General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
  6. 6 Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
  7. 7 Faculty of Dentistry, Universidad de Chile, Independencia, Santiago, Chile
  8. 8 Norwegian Institute of Public Health, Nydalen, Oslo, Norway
  9. 9 Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  10. 10 Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
  11. 11 Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund Faculty of Medicine, Lund University, Lund, Sweden
  12. 12 Oslo University Hospital, Olso, Norway
  13. 13 Richmond, Virginia, USA
  14. 14 Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
  15. 15 University Hospital North Norway, Tromso, Norway
  16. 16 Department of Occupational Therapy, Physiotherapy and Radiography, Faculty of Health and Social sciences, Bergen University College, Bergen, Norway
  17. 17 BMJ Editorial, BMA House, London, UK
  18. 18 Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  19. 19 London, Ontario, Canada
  20. 20 Ingersoll, Ontario, Canada
  21. 21 Department of Health and Science, University of Oslo, Oslo, Norway
  22. 22 Department of Medicine, Hospital Innlandet Trust, Gjøvik, Norway
  1. Correspondence to Reed A C Siemieniuk, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada L8S 4L8, USA; reed.siemieniuk{at}medportal.ca

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What you need to know

  • We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; further research is unlikely to alter this recommendation

  • This recommendation applies to patients with or without imaging evidence of osteoarthritis, mechanical symptoms, or sudden symptom onset

  • Healthcare administrators and funders may use the number of arthroscopies performed in patients with degenerative knee disease as an indicator of quality care.

  • Knee arthroscopy is the most common orthopaedic procedure in countries with available data

  • This Rapid Recommendation package was triggered by a randomised controlled trial published in The BMJ in June 2016 which found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy

What is the role of arthroscopic surgery in degenerative knee disease? An expert panel produced these recommendations based on a linked systematic review triggered by a randomised trial published in The BMJ in June 2016, which found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy. The panel make a strong recommendation against arthroscopy for degenerative knee disease.

Box 1 shows all of the articles and evidence linked in this Rapid Recommendation package. The infographic provides an overview of the absolute benefits and harms of arthroscopy in standard GRADE format. Table 1 below shows any evidence that has emerged since the publication of this article.

Box 1

Linked articles in this BMJ Rapid Recommendations cluster

  • Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 2017;257:j1982. doi:10.1136/bmj.j1982

    • Summary of the results from the Rapid Recommendation process

  • Brignardello-Peterson R, Guyatt GH, Schandelmaier S, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a …

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