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Arthroscopic partial meniscectomy: did it ever work?
Aleksi Reito1, Ian A Harris2, Teemu Karjalainen3
1Department of Orthopaedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Finland.
Abstract:
Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT? A truly effective treatment needs a valid disease model that would biologically and plausibly explain the perceived treatment benefits. In the case of DMT, effectiveness requires a credible framework for the pain-generating process, which should be influenced by APM. Basic research, pathoanatomy, and clinical evidence gives no support to these frameworks. Moreover, treatment of DMT with an APM does not align with the traditional practice of medicine since DMT is not a reliable diagnosis for knee pain and no evidence-based indication exists that would influence patient prognosis from APM. A plausible and robust explanation supported by both basic research and clinical evidence is that DMTs are part of an osteoarthritic disease process and do not contribute to the symptoms independently or in isolation and that symptoms are not treatable with APM. This is further supported by the fact that APM as an intervention is paradoxical because the extent of procedure and severity of disease are both inversely associated with outcome. We argue that arthroscopic treatment of DMT is largely based on a logical fallacy: post hoc ergo propter hoc.
Insights
Arthroscopic partial meniscectomy (APM) for degenerative meniscal tears (DMTs) offers no proven benefits and may cause long-term harm. Current evidence suggests DMTs are part of osteoarthritis and not independently treatable with APM.
Area of Science:
- Orthopedics
- Sports Medicine
- Rheumatology
Background:
- Arthroscopic partial meniscectomy (APM) is a common surgery for degenerative meniscal tears (DMTs).
- High-quality evidence indicates APM provides no significant benefits for DMTs and may lead to long-term harm.
- The effectiveness of APM for DMTs is questioned due to a lack of a valid disease model and supporting evidence.
Purpose of the Study:
- To critically evaluate the historical and current effectiveness of APM in patients with DMTs.
- To examine the biological plausibility and clinical evidence supporting APM for DMTs.
- To determine if APM aligns with established medical practice and evidence-based indications.
Main Methods:
- Narrative review of existing literature.
- Analysis of basic research, pathoanatomy, and clinical evidence.
- Assessment of the diagnostic reliability of DMT and its relationship to knee pain.
Main Results:
- No credible disease model supports APM effectiveness for DMTs.
- DMTs are likely part of a broader osteoarthritic process, not independently symptomatic.
- APM treatment for DMTs lacks evidence-based indications and contradicts established medical principles.
Conclusions:
- APM for DMTs is not supported by scientific evidence and may be based on a logical fallacy.
- DMTs are not a reliable diagnosis for knee pain and are not independently treatable with APM.
- Symptoms associated with DMTs are unlikely to be resolved by APM, especially considering their link to osteoarthritis.
