To assess all the clinical trial evidence for rehabilitation following arthroscopic meniscal surgery.

The following sources were searched: MEDLINE, EMBASE, SPORTDiscus, CINAHL, the National Research Register, the Cochrane Controlled Trials Register, and the UK Chartered Society of Physiotherapy research databases. Additional material was located through handsearches and by contacting the authors of identified studies.

Study designs of evaluations included in the review

Only randomised controlled trials (RCTs) were eligible for inclusion.

Specific interventions included in the review

Any rehabilitative intervention was eligible for inclusion. Specific interventions included in the review were: diclofenac sodium or physiotherapy for 7 days or 1 to 11 days; naproxen (550 mg) for 6 weeks; isokinetic strengthening exercises for 8 weeks; electric stimulation of the quadriceps for 3 weeks; physiotherapy, 9 sessions over 3 weeks; physiotherapy, on average 13.5 sessions over 4.5 weeks; and physiotherapy plus 2 stress inoculation training sessions for 3 weeks. The interventions used in the control groups were: no treatment, placebo, delayed therapy and home exercise.

Participants included in the review

Patients who had undergone arthroscopic meniscal surgery were included.

Outcomes assessed in the review

The authors do not report inclusion criteria relating to the outcomes. The outcomes varied from study to study and included both functional and biomedical outcomes.

How were decisions on the relevance of primary studies made?

The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection.

The authors do not report a formal method for assessing validity. The studies were assessed for the following: whether the study was randomised, whether the intervention was blinded, whether the outcome was blinded, and the number of compliant participants.

The authors do not state how the data were extracted for the review, or how many of the reviewers performed the data extraction. Data were extracted on: author(s) and year of publication; randomisation (yes or no); nature of the control group; nature of the intervention group; sample size; mean age (years); proportion of women (%); duration of the intervention; blinded intervention (yes or no); blinded outcome (yes or no); the number of compliant patients; and the overall result (positive or negative).

How were the studies combined?

A narrative synthesis was undertaken.

How were differences between studies investigated?

Differences between the studies were discussed within the text of the review.

Eight RCTs (n=455) met the inclusion criteria for the review.

In most cases, simple analgesics in the first 1 to 2 days following surgery and a well-planned home-based exercise programme should be sufficient for recovery. It is possible that routine daily non-steroidal anti-inflammatory drugs taken post-operatively for 3 to 6 weeks may enhance recovery rates. One study found that physiotherapy was beneficial for retaining muscle strength and had a positive effect on pain assessment, but this did not translate into functional improvement.

One study reported that the average cost for rehabilitation physiotherapy was US$850, compared with US$40 for their home-based knee exercise programme.

Descriptive studies are required to ascertain the types and duration of treatments being offered to patients after arthroscopic meniscectomy. Further research is needed to perform well-designed studies of current treatments that take into account predisposing factors and their impact on outcome; these should include the use of pre-randomisation and real-life functional outcome measures.

The methodology of this review was generally fair. The search was fairly comprehensive, although only studies published in English were included and the authors limited the inclusion criteria to RCTs. The authors also failed to report on a number of methodological factors. Firstly, the authors only reported vague inclusion criteria a priori. Secondly, they did not provide details on how, or how many reviewers performed the processes of study selection and data extraction. Finally, although the authors made an attempt to assess the validity of the included studies, the findings were not taken into account in the analyses. The narrative synthesis was appropriate given the differences between the included studies, although a more meaningful synthesis may have been possible if standardised end points (e.g. pain scores) had been extracted from the primary studies.

The conclusions drawn by the authors were cautious due to the very general nature of the synthesis. These were supported by the data presented.

Practice: The authors state that orthopaedic surgeons have limited evidence on which to base their clinical decisions. There is insufficient evidence to advocate routine physiotherapy for all patients.

Research: The authors state that well-designed studies of current treatments, which take into account predisposing factors and their impact on outcome, need to be performed. Patients should be pre-randomised to the trials, and outcome measures should involve standardised measures of real-life function rather than biomechanical differences.

Accident Rehabilitation and Compensation Insurance Corporation.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.