To systematically evaluate the efficacy of external application of traditional Chinese medicine(TCM) on the recovery of arthroscopy in patients with knee osteoarthritis(KOA).

Retrieved from Wanfang database, China National Knowledge Infrastructure(CNKI), Database for Chinese Technical Periodicals (VIP), Chinese BioMedical Literature Database(CBM), Cochrane library, Medline, Expecta Medica Database (Embase) and PubMed, randomized controlled trials(RCTs)of external application of TCM for the recovery of arthroscopy in patients with KOA. Inclusion criteria were patients younger than 60 years, and patients with early or mid-term KOA without obvious varus or valgus deformity. Repeated publication and incomplete research data were excluded. The quality evaluation and data extraction were performed. Meta-analysis and trials sequential analysis (TSA)were carried out using RevMan5.3 and TSA v0.9 respectively after document selection, quality evaluation and data extraction.

A total of 15 RCT studies were included, including 1 481 patients. The results of meta analysis suggested that external application of TCM improved the total effective rate of recovery after arthroscopic debridement in KOA patients [relative risk (RR)=1.17, 95% confidence interval (CI)(1.11, 1.22), P<0.0001]. In terms of the pain of knee joint, external application of TCM reduced the visual analogue scale(VAS) score[mean difference(MD)=-1.43, 95%CI(-2.01, -0.84), P<0.0001]. In terms of knee function, external application of TCM increased the Lysholm score [MD=8.39, 95%CI(3.77, 13.01), P=0.0004]. In terms of knee joint symptoms, external application of TCM reduced the symptom score of knee joint[MD=-3.34, 95%CI(-4.31, -2.37), P<0.0001]. In terms of postoperative inflammation indicators, external application of TCM decreased the level of interleukin 1-β[standardized mean difference(SMD)=-3.17, 95%CI(-4.21, -2.14), P<0.0001] and the level of tumor necrosis factor-α[SMD=-1.10, 95%CI(-1.93, -0.26), P=0.01].

External application of TCM has obvious recovery effect after arthroscopic debridement in KOA patients, and the external application method and external application course may further influence the curative effect. However, more multi-center, high-quality RCTs and double-blind trials are necessary to verify the findings.