Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Feb;77(2):188-195.
doi: 10.1136/annrheumdis-2017-211172. Epub 2017 May 18.

Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial

Raine Sihvonen  1 , Mika Paavola  2 , Antti Malmivaara  3 , Ari Itälä  4 , Antti Joukainen  5 , Heikki Nurmi  6 , Juha Kalske  2 , Anna Ikonen  2 , Timo Järvelä  7 , Tero A H Järvinen  8 , Kari Kanto  1 , Janne Karhunen  2 , Jani Knifsund  4 , Heikki Kröger  5 , Tommi Kääriäinen  5 , Janne Lehtinen  1 , Jukka Nyrhinen  6 , Juha Paloneva  6 , Outi Päiväniemi  1 , Marko Raivio  1 , Janne Sahlman  5 , Roope Sarvilinna  2 , Sikri Tukiainen  2 , Ville-Valtteri Välimäki  2 , Ville Äärimaa  4 , Pirjo Toivonen  9 , Teppo L N Järvinen  9 ; FIDELITY (Finnish Degenerative Meniscal Lesion Study) Investigators
Affiliations
Randomized Controlled Trial

Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial

Raine Sihvonen et al. Ann Rheum Dis. 2018 Feb.

Abstract

Objective: To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus.

Methods: In this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35-65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out.

Results: In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, -4.3; 95% CI, -11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (-3.2; -8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (-0.4; -1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups.

Conclusions: In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.

Keywords: knee osteoarthritis; orthopaedic surgery; treatment.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Participant enrolment flow diagram.
Figure 2
Figure 2
Mean values with 95% CIs in all three primary scores during the 24-month follow-up for both groups. APM, arthroscopic partial meniscectomy; NRS, numerical rating scale; WOMET, Western Ontario Meniscal Evaluation Tool.
See this image and copyright information in PMC

References

    1. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report 2009;11:1–25. - PubMed
    1. Abrams GD, Frank RM, Gupta AK, et al. . Trends in meniscus repair and meniscectomy in the United States, 2005-2011. Am J Sports Med 2013;41:2333–9. 10.1177/0363546513495641 - DOI - PubMed
    1. Thorlund JB, Hare KB, Lohmander LS. Large increase in arthroscopic meniscus surgery in the middle-aged and older population in Denmark from 2000 to 2011. Acta Orthop 2014;85:287–92. 10.3109/17453674.2014.919558 - DOI - PMC - PubMed
    1. Kim S, Bosque J, Meehan JP, et al. . Increase in outpatient knee arthroscopy in the United States: a comparison of National surveys of ambulatory surgery, 1996 and 2006. J Bone Joint Surg Am 2011;93:994–1000. 10.2106/JBJS.I.01618 - DOI - PubMed
    1. Montgomery SR, Zhang A, Ngo SS, et al. . Cross-sectional analysis of trends in meniscectomy and meniscus repair. Orthopedics 2013;36:e1007–e1013. 10.3928/01477447-20130724-15 - DOI - PubMed

Publication types