Related Experiment Video
Updated: May 2, 2026
Destabilization of the Medial Meniscus and Cartilage Scratch Murine Model of Accelerated Osteoarthritis
Published on: July 6, 2022
New England journal of medicine article evaluating the usefulness of meniscectomy is flawed
Neal Elattrache1, Christian Lattermann2, Michael Hannon3
1Kerlan-Jobe Orthopaedic Foundation and Sports Medicine Fellowship, Los Angeles, California, U.S.A.
Abstract:
A controversial article was recently published in the New England Journal of Medicine titled "Arthroscopic Partial Meniscectomy Versus Sham Surgery for a Degenerative Meniscal Tear" by Sihvonen et al. We believe that readers of this article should be careful about making sweeping generalizations regarding the study findings given several methodologic flaws inherent in the population studied. There are significant concerns regarding the generalizability of these data. The actual study sample group is exceedingly small as compared with the normal volume of meniscal surgery the authors are reported to routinely perform. The authors' definition of a sham procedure must be revisited. The authors' final conclusion that "arthroscopic partial meniscectomy is of no value" is simply not what the study found. We share the concerns that several other leading authorities have recently expressed about the societal implications of this work. Arthroscopic partial meniscectomy has revolutionized the way we are able to treat symptomatic meniscal pathology. However, this procedure, like all surgical procedures, must be properly indicated to truly benefit our patients.
Insights
This study questions the value of arthroscopic partial meniscectomy for degenerative meniscal tears, but its small sample size and flawed methodology limit generalizability. Further research is needed to confirm findings on this common knee surgery.
Area of Science:
- Orthopedic Surgery
- Knee Arthroscopy
- Biomedical Research Methodology
Background:
- A recent study in the New England Journal of Medicine questioned the efficacy of arthroscopic partial meniscectomy for degenerative meniscal tears.
- The study by Sihvonen et al. has generated controversy due to its methodological limitations and conclusions.
Purpose of the Study:
- To critically evaluate the methodology and generalizability of the Sihvonen et al. study.
- To address concerns regarding the study's small sample size and definition of sham procedures.
- To discuss the implications of the study's findings on the established role of arthroscopic partial meniscectomy.
Main Methods:
- Critique of the study's sample size and its comparison to typical surgical volumes.
- Analysis of the definition and execution of the sham procedure in the Sihvonen et al. study.
- Review of the statistical analysis and interpretation of results presented in the original article.
Main Results:
- The study sample size was deemed exceedingly small, raising concerns about statistical power and generalizability.
- The definition of the sham procedure was found to be questionable, potentially impacting the validity of comparisons.
- The authors' conclusion that arthroscopic partial meniscectomy is "of no value" was deemed an overstatement not fully supported by the study's data.
Conclusions:
- The findings of the Sihvonen et al. study should be interpreted with caution due to significant methodologic flaws.
- Generalizing the study's conclusions to the broader patient population undergoing meniscal surgery is not advisable.
- Arthroscopic partial meniscectomy remains a valuable treatment for symptomatic meniscal pathology when properly indicated, despite the controversy raised by this study.
