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. 2017 Apr 10;5(4):2325967117698439.
doi: 10.1177/2325967117698439. eCollection 2017 Apr.

Changes Within Clinical Practice After a Randomized Controlled Trial of Knee Arthroscopy for Osteoarthritis

Nirav H Amin  1 , Waqas Hussain  2 , John Ryan  3 , Shannon Morrison  4 , Anthony Miniaci  4 , Morgan H Jones  5
Affiliations

Changes Within Clinical Practice After a Randomized Controlled Trial of Knee Arthroscopy for Osteoarthritis

Nirav H Amin et al. Orthop J Sports Med. .

Abstract

Background: In 2002, Moseley et al published a randomized controlled trial (RCT) that showed no difference between knee arthroscopy and placebo for patients with osteoarthritis (OA). We wanted to assess the impact of the trial on clinical practice in the United States.

Purpose/hypothesis: To evaluate changes in knee arthroscopy practice before and after publication of the article by Moseley et al and to assess the effect of this landmark RCT on the behavior of practicing orthopaedic surgeons. We hypothesized that after publication of the Moseley trial, the overall frequency of knee arthroscopy would decrease, that the mean age of patients undergoing knee arthroscopy would decrease, and that the proportion of arthroscopies for a diagnosis of OA would decrease.

Study design: Descriptive epidemiology study.

Methods: The State Ambulatory Surgery Database was used to analyze cases from 1998 to 2006, which were classified as meniscus tear, OA, or OA with meniscus tear. Changes in age, surgery rates, and case classification were evaluated before and after Moseley's trial using Student t tests and analysis of variance.

Results: After publication of the trial, the number of knee arthroscopies per year increased from 155,057 in 1998 to 172,317 in 2006 (P ≤ .001). Mean patient age increased from 47.6 to 49.2 years (P < .001). Meniscus tears increased from 69.1% to 70.8%, representing approximately 15,500 additional cases per year. OA decreased from 10.6% to 7.2%, representing approximately 4000 fewer cases per year. OA with meniscus tear increased from 20.3% to 22.0%, representing approximately 6400 additional cases per year.

Conclusion: While overall age and rates of knee arthroscopy increased contrary to our hypothesis, we identified a decrease in rates of knee arthroscopy for OA after publication of the Moseley trial, demonstrating that well-publicized RCTs can influence patterns of clinical practice.

Keywords: knee arthoscopy; meniscus tears; osteoarthritis.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by an intramural research grant from the Cleveland Clinic Foundation.

Figures

Figure 1.
Figure 1.
Graphic display of yearly frequency of knee arthroscopy from 1998 to 2006. The vertical dotted line indicates 2003, which is defined as a reference point for the publication of Moseley’s research.
Figure 2.
Figure 2.
Percent of arthroscopies performed for each diagnosis. M, meniscal tear; OA, osteoarthritis; OAM, osteoarthritis and meniscus tear.
See this image and copyright information in PMC

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