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Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear
Raine Sihvonen1, Mika Paavola, Antti Malmivaara
1From the Department of Orthopedics and Traumatology, Hatanpää City Hospital, Tampere (R.S.), the Department of Orthopedics and Traumatology, Helsinki University Central Hospital and University of Helsinki (M.P., J.K., T.L.N.J.), and the National Institute for Health and Welfare, Center for Health and Social Economics (A.M.), Helsinki, the Department of Orthopedics and Traumatology, University of Turku, Turku (A.I.), the Department of Orthopedics, Traumatology, and Hand Surgery, Kuopio University Hospital, Kuopio (A.J.), and the Department of Orthopedics and Traumatology, Central Finland Central Hospital, Jyväskylä (H.N.) - all in Finland.
Background:
Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.
Methods:
We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100, with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure.
Results:
In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, -1.6 points; 95% confidence interval [CI], -7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, -2.5 points; 95% CI, -9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, -0.1; 95% CI, -0.9 to 0.7). There were no significant differences between groups in the number of patients who required subsequent knee surgery (two in the partial-meniscectomy group and five in the sham-surgery group) or serious adverse events (one and zero, respectively).
Conclusions:
In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure. (Funded by the Sigrid Juselius Foundation and others; ClinicalTrials.gov number, NCT00549172.).
Insights
Arthroscopic partial meniscectomy for degenerative meniscus tears showed no benefit over sham surgery. This common orthopedic procedure did not yield better outcomes than a placebo surgery in patients without osteoarthritis.
Area of Science:
- Orthopedics
- Surgical Innovation
- Clinical Trials
Background:
- Arthroscopic partial meniscectomy is a frequent orthopedic intervention.
- Evidence supporting its effectiveness is limited.
- Degenerative medial meniscus tears are common indications for this surgery.
Purpose of the Study:
- To evaluate the efficacy of arthroscopic partial meniscectomy compared to sham surgery.
- To assess outcomes in patients with degenerative medial meniscus tears and no knee osteoarthritis.
- To determine if surgical intervention offers superior results to a placebo procedure.
Main Methods:
- A multicenter, randomized, double-blind, sham-controlled trial was conducted.
- 146 patients aged 35-65 with degenerative medial meniscus tears (no osteoarthritis) were enrolled.
- Patients received either arthroscopic partial meniscectomy or sham surgery, with outcomes assessed at 12 months.
Main Results:
- No significant differences were observed between the partial meniscectomy and sham surgery groups for primary outcomes (Lysholm, WOMET, pain after exercise).
- Improvements in scores were comparable between the surgical and sham groups.
- Rates of subsequent knee surgery and serious adverse events did not differ significantly between the groups.
Conclusions:
- Arthroscopic partial meniscectomy provided no superior outcomes compared to sham surgery in patients with degenerative medial meniscus tears and no knee osteoarthritis.
- The findings question the routine use of this procedure in this patient population.
- Further research may be needed to establish the role of arthroscopic partial meniscectomy.
