Statistically Fragile Evidence Underlies Comparative Trials of Arthroscopic Meniscectomy Versus Nonoperative Management for Degenerative Meniscus Tears

Purpose To assess the statistical robustness of comparative studies and randomized controlled trials (RCTs) comparing arthroscopic meniscal debridement or meniscectomy with nonoperative or sham interventions. Methods Comparative studies and RCTs of meniscus debridement or meniscectomy versus nonoperative or sham interventions were identified through a comprehensive literature search in June 2025 following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Study characteristics, dichotomous outcomes, and continuous outcomes were extracted. The fragility index and continuous fragility index were calculated as the number of event reversals required to change significance; these metrics were normalized by sample size to calculate the fragility quotient (FQ) and continuous FQ. Results Of 429 studies screened, 10 were included (5 RCTs, 5 comparative), yielding 50 dichotomous (e.g., progression to arthroplasty or adverse events) and 83 continuous (e.g., Knee Injury and Osteoarthritis Outcome Score subscales, International Knee Documentation committee scores, pain visual analog scale scores, etc.) outcomes. The median fragility index was 6 (interquartile range [IQR] 4‐12.75) with median FQ of 0.031 (IQR 0.014‐0.049). The median continuous fragility index was 18 (IQR 6.8‐41.5) with median continuous FQ of 0.13 (IQR 0.084‐0.16). Dichotomous outcomes from RCTs were significantly more fragile than those from comparative studies (RCT FQ = 0.021 vs 0.049; P = .010), whereas continuous outcome fragility did not differ significantly. Conclusions Studies comparing meniscal debridement with nonoperative management are statistically fragile, meaning that statistical significance could be reversed with only a small number of outcome changes, particularly for dichotomous outcomes. Continuous outcomes showed greater robustness but remained limited by loss to follow‐up and study design. Level of Evidence Level III, systematic review of Level I to III studies.