Risk of total knee replacement after a meniscal tear treated with arthroscopic partial meniscectomy compared to nonoperative treatment: A systematic review.

Objective: Knee Osteoarthritis (OA) is a leading cause of disability worldwide. Many of those with OA have imaging evidence of a meniscal tear which can be treated with arthroscopic partial meniscectomy (APM) or nonoperatively. If symptoms persist after meniscal tear treatment, a total knee arthroplasty (TKA) is often offered if patients have concomitant advanced OA. We sought to assess differences in rates of TKA after five years in patients with meniscal tear who were treated with APM vs nonoperative treatments using existing literature. Design: Using the PubMed database, we performed a systematic literature review to identify papers comparing eventual TKA rates in patients with meniscal tear treated with APM vs nonoperative management. We abstracted pertinent information on study design and patient population. We extracted five-year TKA rates for operative and nonoperative groups using reported values or estimates derived from provided Kaplan-Meier (KM) curves. Results: Our search returned seven studies, which varied in design, sample size, and primary outcome. Some studies were restricted to root tears, which are associated with higher rates of progression to TKA. Five-year TKA incidence ranged from 2.2% to 54.0% in the APM group and 2.9%-34.6% in the nonoperative group. All but one paper indicated that those in the APM group progressed to TKA at higher rates than those in the nonoperative group. Conclusions: Prior surgical interventions for meniscal tear may increase incidence of future TKA compared to nonoperative intervention. These findings may prompt further investigation into the relationship between APM and incidence of TKA.