Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial
Two articles on PainSci cite Sihvonen 2016: 1. The Complete Guide to Patellofemoral Pain Syndrome 2. Knee Surgery Sure is Useless!
PainSci notes on Sihvonen 2016:
A medium-sized trial comparing meniscectomy to a sham made no difference for patients with “catching or occasional locking,” even though these kinds of symptoms are still widely regarded as a stronger reason to attempt surgical treatment.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: Recent evidence shows that arthroscopic partial meniscectomy (APM) offers no benefit over conservative treatment of patients with a degenerative meniscus tear. However, patients who report mechanical symptoms (sensations of knee catching or locking) may benefit from APM.
OBJECTIVE: To assess whether APM improves mechanical symptoms better than sham surgery.
DESIGN: Randomized, patient- and outcome assessor-blinded, sham surgery-controlled, multicenter trial. (ClinicalTrials.gov: NCT00549172).
SETTING: 5 orthopedic clinics in Finland.
PATIENTS: Adults (aged 35 to 65 years) with a degenerative medial meniscus tear and no knee osteoarthritis.
INTERVENTION: APM or sham surgery.
MEASUREMENTS: Patients' self-report of mechanical symptoms before surgery and at 2, 6, and 12 months after surgery.
RESULTS: 70 patients were randomly assigned to APM, and 76 were assigned to sham surgery. Thirty-two patients (46%) in the APM group and 37 (49%) in the sham surgery group reported catching or locking before surgery; the corresponding numbers at any follow-up were 34 (49%) and 33 (43%), with a risk difference of 0.03 (95% CI, -0.06 to 0.12). In the subgroup of 69 patients with preoperative catching or locking, the risk difference was 0.07 (CI, -0.08 to 0.22).
LIMITATION: Analyses were post hoc, and the results are only generalizable to knee catching and occasional locking because few patients reported other types of mechanical symptoms.
CONCLUSION: Resection of a torn meniscus has no added benefit over sham surgery to relieve knee catching or occasional locking. These findings question whether mechanical symptoms are caused by a degenerative meniscus tear and prompt caution in using patients' self-report of these symptoms as an indication for APM.
PRIMARY FUNDING SOURCE: Academy of Finland.
- “Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up,” Kise et al, British Medical Journal, 2016.
- “Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear,” Sihvonen et al, New England Journal of Medicine, 2013.
- “A Systematic Review of Clinical Outcomes in Patients Undergoing Meniscectomy,” Salata et al, American Journal of Sports Medicine, 2010.
- “The Right to Know That an Operation Is ‘Next to Useless’,” Gina Kolata, www.nytimes.com.
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