Needle arthroscopy as an emerging office-based tool: Promising diagnostic value but limited evidence for therapeutic equivalence-A systematic review and frequentist meta-analysis.
Source: PubMed, NCBI / U.S. National Library of Medicine
Needle (Nano) arthroscopy is an emerging minimally invasive technique primarily used for diagnostic assessment and selected therapeutic procedures that may facilitate office-based joint evaluation. However, comparative evidence regarding functional outcomes, procedural performance and safety remains limited. This systematic review and meta-analysis compared needle arthroscopy with conventional arthroscopy regarding functional outcomes, diagnostic performance and complication rates. Comparative studies of needle arthroscopy versus conventional arthroscopy were pooled using random-effects meta-analysis with Hartung-Knapp adjustment. Dichotomous outcomes were analysed as odds ratios (ORs) and continuous outcomes as mean differences (MDs), both with 95% confidence intervals (CIs). Functional outcomes, procedural success, complications and diagnostic performance were quantitatively synthesized. Between-study heterogeneity was assessed usingand, and diagnostic parameters were analysed exploratorily when required data were reconstructed from reported percentages. Nine studies including 503 patients were analysed. Needle arthroscopy and conventional arthroscopy demonstrated comparable procedure completion (OR 1.00, 95% CI 0.17-5.93) and diagnostic success (OR 1.01, 95% CI 0.10-10.07). Complication rates were low and similar between groups (OR 1.00, 95% CI 0.20-5.06), with no differences in infection or reoperation. Needle arthroscopy showed improved functional outcomes at 0.5 months
Abstract
Needle (Nano) arthroscopy is an emerging minimally invasive technique primarily used for diagnostic assessment and selected therapeutic procedures that may facilitate office-based joint evaluation. However, comparative evidence regarding functional outcomes, procedural performance and safety remains limited. This systematic review and meta-analysis compared needle arthroscopy with conventional arthroscopy regarding functional outcomes, diagnostic performance and complication rates. Comparative studies of needle arthroscopy versus conventional arthroscopy were pooled using random-effects meta-analysis with Hartung-Knapp adjustment. Dichotomous outcomes were analysed as odds ratios (ORs) and continuous outcomes as mean differences (MDs), both with 95% confidence intervals (CIs). Functional outcomes, procedural success, complications and diagnostic performance were quantitatively synthesized. Between-study heterogeneity was assessed usingand, and diagnostic parameters were analysed exploratorily when required data were reconstructed from reported percentages. Nine studies including 503 patients were analysed. Needle arthroscopy and conventional arthroscopy demonstrated comparable procedure completion (OR 1.00, 95% CI 0.17-5.93) and diagnostic success (OR 1.01, 95% CI 0.10-10.07). Complication rates were low and similar between groups (OR 1.00, 95% CI 0.20-5.06), with no differences in infection or reoperation. Needle arthroscopy showed improved functional outcomes at 0.5 months (KOOS4 [KOOS composite score (mean of four subscales)]: MD +15.25, 95% CI 7.82-22.67) and maintained a significant advantage at 1.5 months (MD +7.25, 95% CI 0.27-14.22). Exploratory diagnostic analyses revealed no significant differences in sensitivity or specificity. Certainty of evidence ranged from moderate to very low. Needle arthroscopy provides comparable diagnostic and procedural performance to conventional arthroscopy and offers an early functional advantage. However, while current evidence is insufficient to replace conventional arthroscopy as the reference standard, needle arthroscopy may represent a valuable adjunct or emerging alternative in selected clinical settings. Level III, systematic review and meta-analysis of predominantly retrospective cohort studies.