Arthroscopic partial meniscectomy for the degenerative meniscus tear: a comparison of patients included in RCTs and prospective cohort studies

• Published in: Acta orthopaedica Vol. 94; pp. 570 - 576
• Main Authors: Wijn, Stan R W, Hannink, Gerjon, Thorlund, Jonas B, Sihvonen, Raine, Englund, Martin, Rovers, Maroeska M
• Format: Journal Article
• Language: English
• Published: Sweden Medical Journals Sweden 30.11.2023
• Subjects: Arthroscopy; Arthroscopy - adverse effects; Arthroscopy - methods; Clinical Medicine; Cohort Studies; Degenerative meniscus tear; Humans; IPDMA; Klinisk medicin; Knee; Knee Joint - surgery; Medical and Health Sciences; Medicin och hälsovetenskap; Meniscectomy; Meniscectomy - adverse effects; Meniscectomy - methods; Menisci, Tibial - surgery; Meniscus; Osteoarthritis; Osteoarthritis, Knee - surgery; Pain; Randomized Controlled Trials as Topic; Reumatologi och inflammation; Rheumatology and Autoimmunity
• ISSN: 1745-3674; 1745-3682
• DOI: 10.2340/17453674.2023.24576

Concerns exist regarding the generalizability of results from randomized controlled trials (RCTs) evaluating arthroscopic partial meniscectomy (APM) to treat degenerative meniscus tears. It has been suggested that study populations are not representative of subjects selected for surgery in daily clinical practice. Therefore, we aimed to compare patients included in trials and prospective cohort studies that received APM for a degenerative meniscus tear. Individual participant data from 4 RCTs and 2 cohort studies undergoing APM were collected. 1,970 patients were analyzed: 605 patients included in RCTs and 1,365 included in the cohorts. We compared patient and disease characteristics, knee pain, overall knee function, and health-related quality of life at baseline between the RCT and cohort groups using standardized differences, ratios comparing the variance of continuous covariates, and graphical methods such as quantile-quantile plots, side-by-side boxplots, and non-parametric density plots. Differences between RCT and the cohort were observed primarily in age (younger patients in the cohort; standardized difference: 0.32) and disease severity, with the RCT group having more severe symptoms (standardized difference: 0.38). While knee pain, overall knee function, and quality of life generally showed minimal differences between the 2 groups, it is noteworthy that the largest observed difference was in knee pain, where the cohort group scored 7 points worse (95% confidence interval 5-9, standardized difference: 0.29). Patients in RCTs were largely representative of those in cohort studies regarding baseline scores, though variations in age and disease severity were observed. Younger patients with less severe osteoarthritis were more common in the cohort; however, trial participants still appear to be broadly representative of the target population.