Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial

Abstract

Objectives: To assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at 5 years follow-up.

Design: Multicentre, randomised, participant- and outcome assessor-blinded, placebo-surgery controlled trial.

Setting: Orthopaedic departments in five public hospitals in Finland.

Participants: 146 adults, mean age 52 years (range 35-65 years), with knee symptoms consistent with degenerative medial meniscus tear verified by MRI scan and arthroscopically, and no clinical signs of knee osteoarthritis were randomised.

Interventions: APM or placebo surgery (diagnostic knee arthroscopy).

Main outcome measures: We used two indices of radiographic knee osteoarthritis (increase in Kellgren and Lawrence grade ≥1, and increase in Osteoarthritis Research Society International (OARSI) atlas radiographic joint space narrowing and osteophyte sum score, respectively), and three validated patient-relevant measures of knee symptoms and function (Western Ontario Meniscal Evaluation Tool (WOMET), Lysholm, and knee pain after exercise using a numerical rating scale).

Results: There was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the APM group as compared with the placebo surgery group (adjusted absolute risk difference in increase in Kellgren-Lawrence grade ≥1 of 13%, 95% CI -2% to 28%; adjusted absolute mean difference in OARSI sum score 0.7, 95% CI 0.1 to 1.3). There were no relevant between-group differences in the three patient-reported outcomes: adjusted absolute mean differences (APM vs placebo surgery), -1.7 (95% CI -7.7 to 4.3) in WOMET, -2.1 (95% CI -6.8 to 2.6) in Lysholm knee score, and -0.04 (95% CI -0.81 to 0.72) in knee pain after exercise, respectively. The corresponding adjusted absolute risk difference in the presence of mechanical symptoms was 18% (95% CI 5% to 31%); there were more symptoms reported in the APM group. All other secondary outcomes comparisons were similar.

Conclusions: APM was associated with a slightly increased risk of developing radiographic knee osteoarthritis and no concomitant benefit in patient-relevant outcomes, at 5 years after surgery.

Trial registration: ClinicalTrials.gov (NCT01052233 and NCT00549172).

Keywords: meniscus; osteoarthritis.

Figure 1

Study flowchart.

Figure 2

Change in OARSI sum score from baseline to 5 year follow-up in the APM (blank bars) and placebo surgery (dark bars) groups. The x-axis shows the difference between 5 year and baseline OARSI sum score, while the y-axis shows the percentage of participants with each change score, per treatment arm. The higher the bars are at the right end of the x-axis, the more participants with more advanced progression of OA (higher OARSI score). APM, arthroscopic partial meniscectomy; OA, osteoarthritis; OARSI, Osteoarthritis Research Society International.

Figure 3

Mean values with 95% confidence intervals in all three primary scores during the 60 month follow-up for both groups. APM, arthroscopic partial meniscectomy.