Guideline: An expert panel strongly recommends against arthroscopic knee surgery for degenerative knee disease

Research output: Contribution to journalComment/debateResearchpeer-review

1 Citation (Scopus)

Abstract

The guideline by Siemieniuk and colleagues is 1 of a new series
from BMJ called “Rapid Recommendations” (1). The panel of methodologic
systematic reviewers and content experts carefully reviewed
the literature and found no good reason to offer arthroscopy
for osteoarthritis of the knee: Compared with controls, every
important outcome was either worse or not different after arthroscopy.
The authors take great care to explain the evidence to patients
and their clinicians. The electronic version of the paper
(www.bmj.com/content/357/bmj.j1982.long) is worth exploring,
together with the MAGICapp site linked within, and then saving the
site to use when explaining the recommendation to patients.
Patients often start with overoptimistic assumptions about the benefits
of medical care (2), and this resource should help them to understand
the benefits and harms of arthroscopy for osteoarthritis of
the knee (no patient-important or lasting benefits, some harm!).
For example, some outcomes not captured in the print summary
(such as a statistically nonsignificant almost doubling of the chance
of knee replacement from 12 to 23 in 1000 patients over a period
of 1 to 2 years) are included in the online versions.
The online presentation looks a lot like a patient decision aid,
although it has not been evaluated with patients (yet)—one of
the criteria recommended by the International Patient Decision
Aid Standards (3). Nonetheless, the publication by Siemieniuk
and colleagues is welcome. Perhaps it will become routine, with
more journals publishing evidence in a
way that is immediately useful to practicing
clinicians as they support patients in
making informed clinical decisions.
Chris Del Mar, MD
Bond University
Gold Coast, Queensland, Australia
References
1. Siemieniuk RA, Agoritsas T, Macdonald H,
et al. Introduction to BMJ Rapid Recommendations
(Editorial). BMJ. 2016;354:i5191.
2. Hoffmann TC, Del Mar C. Patients' expectations
of the benefits and harms of treatments,
screening, and tests: a systematic review. JAMA
Intern Med. 2015;175:274-86.
3. Elwyn G, O’Connor A, Stacey D, et al; International
Patient Decision Aids Standards
(IPDAS) Collaboration. Developing a quality
criteria framework for patient decision aids: online
international Delphi consensus process.
BMJ. 2006;333:417.
Original languageEnglish
Pages (from-to)JC38-JC38
Number of pages1
JournalAnnals of Internal Medicine
Volume167
Issue number8
DOIs
Publication statusPublished - 17 Oct 2017

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Arthroscopy
Knee
Guidelines
Decision Support Techniques
Mars
Knee Osteoarthritis
Queensland
Publications

Cite this

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title = "Guideline: An expert panel strongly recommends against arthroscopic knee surgery for degenerative knee disease",
abstract = "The guideline by Siemieniuk and colleagues is 1 of a new seriesfrom BMJ called “Rapid Recommendations” (1). The panel of methodologicsystematic reviewers and content experts carefully reviewedthe literature and found no good reason to offer arthroscopyfor osteoarthritis of the knee: Compared with controls, everyimportant outcome was either worse or not different after arthroscopy.The authors take great care to explain the evidence to patientsand their clinicians. The electronic version of the paper(www.bmj.com/content/357/bmj.j1982.long) is worth exploring,together with the MAGICapp site linked within, and then saving thesite to use when explaining the recommendation to patients.Patients often start with overoptimistic assumptions about the benefitsof medical care (2), and this resource should help them to understandthe benefits and harms of arthroscopy for osteoarthritis ofthe knee (no patient-important or lasting benefits, some harm!).For example, some outcomes not captured in the print summary(such as a statistically nonsignificant almost doubling of the chanceof knee replacement from 12 to 23 in 1000 patients over a periodof 1 to 2 years) are included in the online versions.The online presentation looks a lot like a patient decision aid,although it has not been evaluated with patients (yet)—one ofthe criteria recommended by the International Patient DecisionAid Standards (3). Nonetheless, the publication by Siemieniukand colleagues is welcome. Perhaps it will become routine, withmore journals publishing evidence in away that is immediately useful to practicingclinicians as they support patients inmaking informed clinical decisions.Chris Del Mar, MDBond UniversityGold Coast, Queensland, AustraliaReferences1. Siemieniuk RA, Agoritsas T, Macdonald H,et al. Introduction to BMJ Rapid Recommendations(Editorial). BMJ. 2016;354:i5191.2. Hoffmann TC, Del Mar C. Patients' expectationsof the benefits and harms of treatments,screening, and tests: a systematic review. JAMAIntern Med. 2015;175:274-86.3. Elwyn G, O’Connor A, Stacey D, et al; InternationalPatient Decision Aids Standards(IPDAS) Collaboration. Developing a qualitycriteria framework for patient decision aids: onlineinternational Delphi consensus process.BMJ. 2006;333:417.",
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}

Guideline: An expert panel strongly recommends against arthroscopic knee surgery for degenerative knee disease. / Del Mar, Chris B.

In: Annals of Internal Medicine, Vol. 167, No. 8, 17.10.2017, p. JC38-JC38.

Research output: Contribution to journalComment/debateResearchpeer-review

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N2 - The guideline by Siemieniuk and colleagues is 1 of a new seriesfrom BMJ called “Rapid Recommendations” (1). The panel of methodologicsystematic reviewers and content experts carefully reviewedthe literature and found no good reason to offer arthroscopyfor osteoarthritis of the knee: Compared with controls, everyimportant outcome was either worse or not different after arthroscopy.The authors take great care to explain the evidence to patientsand their clinicians. The electronic version of the paper(www.bmj.com/content/357/bmj.j1982.long) is worth exploring,together with the MAGICapp site linked within, and then saving thesite to use when explaining the recommendation to patients.Patients often start with overoptimistic assumptions about the benefitsof medical care (2), and this resource should help them to understandthe benefits and harms of arthroscopy for osteoarthritis ofthe knee (no patient-important or lasting benefits, some harm!).For example, some outcomes not captured in the print summary(such as a statistically nonsignificant almost doubling of the chanceof knee replacement from 12 to 23 in 1000 patients over a periodof 1 to 2 years) are included in the online versions.The online presentation looks a lot like a patient decision aid,although it has not been evaluated with patients (yet)—one ofthe criteria recommended by the International Patient DecisionAid Standards (3). Nonetheless, the publication by Siemieniukand colleagues is welcome. Perhaps it will become routine, withmore journals publishing evidence in away that is immediately useful to practicingclinicians as they support patients inmaking informed clinical decisions.Chris Del Mar, MDBond UniversityGold Coast, Queensland, AustraliaReferences1. Siemieniuk RA, Agoritsas T, Macdonald H,et al. Introduction to BMJ Rapid Recommendations(Editorial). BMJ. 2016;354:i5191.2. Hoffmann TC, Del Mar C. Patients' expectationsof the benefits and harms of treatments,screening, and tests: a systematic review. JAMAIntern Med. 2015;175:274-86.3. Elwyn G, O’Connor A, Stacey D, et al; InternationalPatient Decision Aids Standards(IPDAS) Collaboration. Developing a qualitycriteria framework for patient decision aids: onlineinternational Delphi consensus process.BMJ. 2006;333:417.

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DO - 10.7326/ACPJC-2017-167-8-038

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JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

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