OBJECTIVE: To assess the benefit of arthroscopic partial meniscectomy (APM) in adults with a meniscal tear and knee pain in three defined populations (taking account of the comparison intervention): (A) all patients (any type of meniscal tear with or without radiographic osteoarthritis); (B) patients with any type of meniscal tear in a non-osteoarthritic knee; and (C) patients with an unstable meniscal tear in a non-osteoarthritic knee. DESIGN: Systematic review and meta-analysis. DATA SOURCES: A search of Medline, Embase, CENTRAL, Scopus, Web of Science, ClinicalTrials.gov and ISRCTN was performed, unlimited by language or publication date (inception to 18 October 2018). ELIGIBILITY CRITERIA: Randomised controlled trials performed in adults with meniscal tears, comparing APM versus (1) non-surgical intervention; (2) pharmacological intervention; (3) surgical intervention; and (4) no intervention. RESULTS: Ten trials were identified: seven compared with non-surgery, one pharmacological and two surgical. Findings were limited by small sample size, small number of trials and cross-over of participants to APM from comparator interventions. In group A (all patients) receiving APM versus non-surgical intervention (physiotherapy), at 6 to 12 months, there was a small mean improvement in knee pain (standardised mean difference (SMD) 0.22 (95% CI 0.03 to 0.40); five trials, 943 patients; I2 = 48%; Grading of Recommendations Assessment, Development and Evaluation (GRADE) low), knee-specific quality of life (SMD 0.43 (95% CI 0.10 to 0.75); three trials, 350 patients; I2 = 56%; GRADE: low) and knee function (SMD 0.18 (95% CI 0.04 to 0.33); six trials, 1050 patients; I2 = 27%; GRADE low). When the analysis was restricted to people without osteoarthritis (group B), there was a small to moderate improvement in knee pain (SMD 0.35 (95% CI 0.04 to 0.66); three trials, 402 patients; I2 = 58%; GRADE very low), knee-specific quality of life (SMD 0.59 (95% CI 0.11 to 1.07); two trials, 244 patients; I2 = 71%; GRADE low) and knee function (SMD 0.30 (95% CI 0.06 to 0.53); four trials, 507 patients; I2 = 44%; GRADE very low). There was no improvement in knee pain, function or quality of life in patients receiving APM compared with placebo surgery at 6 to 12 months in group A or B (pain SMD 0.08 (95% CI -0.24 to 0.41); one trial, 146 patients; GRADE low; function SMD -0.08 (95% CI -0.41 to 0.24); one trial, 146 patients; GRADE high; quality of life SMD 0.05 (95% CI -0.27 to 0.38); one trial; 146 patients; GRADE high). No trials were identified for people in group C. CONCLUSION: Performing APM in all patients with knee pain and a meniscal tear is not appropriate, and surgical treatment should not be considered the first-line intervention. There may, however, be a small-to-moderate benefit from APM compared with physiotherapy for patients without osteoarthritis. No trial has been limited to patients failing non-operative treatment or patients with an unstable meniscal tear in a non-arthritic joint; research is needed to establish the value of APM in this population. PROTOCOL REGISTRATION NUMBER: PROSPERO CRD42017056844.
Reproduced with permission from the BMJ Publishing Group.

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