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

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.