|Beitragstitel||Home-based programs vs standard rehabilitation following knee meniscectomy|
Importance: Arthroscopic meniscectomy (AM) is one of the most common orthopaedic procedures, but the optimal post-operative approach is still debated.
Objective: To compare the effectiveness of home-based programs (HBP) versus standard inpatient and/or outpatient supervised physical therapy (IOP) following AM.
Data Sources: A systematic literature research was conducted on PubMed, Web of Science, Cochrane Library, and Scopus databases on November 1, 2020.
Study Selection: RCTs of patients treated with HBP versus IOP after AM were included. Non-randomized studies, expert opinions (level of evidence 2-5), systematic reviews, and meta-analyses were excluded.
Data Extraction and Synthesis: Data were independently screened and extracted by two authors according to the Preferred Reporting Items for Systematic Reviews with disagreements solved by consensus. A fixed-effects model was favoured in the absence of significant heterogeneity (I2 < 25%), otherwise a random-effects model was employed, and the Knapp Hartung correction was applied.
Main Outcomes and Measures: The primary outcome was the Lysholm score and secondary outcomes were subjective IKDC score, knee extension and flexion RoM, thigh girth, horizontal and vertical hop test, and days to return to work, as indicated in the previous PROSPERO registration.
Results: In this meta-analysis of eight RCTs on 434 patients, no statistically significant between-groups difference in Lysholm score was documented, both at short-term, with a standardized mean difference (SMD) of -0.78 (95% confidence interval (CI) = -1.63 – 0.08; p=0.065), and at mid-term, with a SMD of -0.31 (95% CI = -0.67 – 0.05; p=0.095). Similar results were found also for secondary outcomes. A statistically significant between-groups short-term difference emerged only for the vertical hop test score, favouring IOP, with an SMD of -0.42 (95% CI = CI -0.80 – -0.03; p < 0.05). A sensitivity analysis of the primary outcome was also performed and confirmed the study findings.
Conclusions and Relevance: No intervention demonstrated to be more effective in terms of physical outcomes as well as work-related and patient-reported outcomes, both at short- and mid-term follow-up. IOP showed only a slightly more favorable functional outcome in the short-term. Overall results showed HBP to be an effective management after AM in the general population.