Partial meniscectomy not superior to sham surgery for meniscal tear

Image: PD 

1. Patients who underwent arthroscopic partial meniscectomy did not have significant improvement in outcomes when compared to those who underwent a sham surgery. 

2. There was no significant difference between groups in the number of patients requiring subsequent knee surgery or in the occurrence of serious adverse events. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Meniscal tears are a common knee injury and are often treated with arthroscopic medial meniscectomy. Although it is frequently performed, there is limited evidence from clinical trials to support the efficacy of this procedure. This multicentre, randomized, controlled trial including patients with degenerative medial meniscus tears found no significant difference in outcomes between arthroscopic partial meniscectomy and a sham surgical procedure. This suggests that patients may be undergoing unnecessary treatment and incurring excess cost to the health care system. The strength of this study lies in the design, which included blinding of patients, data collectors, and data analyzers, facilitated by the use of a sham surgery. It has been suggested that patients undergoing arthroscopic partial meniscectomy may be at a higher risk of developing osteoarthritis. Untreated tears are also at risk of developing into osteoarthritis. Prolonged follow-up will be required in order to assess these long-term outcomes.

Click to read the study, published today in NEJM

Relevant Reading: Surgery versus physical therapy for a meniscal tear and osteoarthritis

In-Depth [randomized, controlled study]: This multicentre, double-blind, randomized, controlled trial assigned 146 patients with symptoms of a degenerative medial meniscal tear and without signs of osteoarthritis to undergo athroscopic partial meniscectomy or a sham surgery. The primary outcomes were the changes from baseline to 12 months in the Lysholm knee score, the Western Ontario Meniscal Evaluation Tool (WOMET) score, and knee pain following exercise assessed on a scale from 0 (no pain) to 10 (extreme pain). The Lysholm and WOMET scores both range from 0 to 100, with 0 indicating severe symptoms and 100 indicating no symptoms. Improvements in the three outcome measures were observed in both groups at 12 months; however, no significant between-group differences were observed. The mean between-group difference in improvement in the Lysholm knee score was -1.6 points (95% confidence interval [CI], -7.2 to 4.0), that in the WOMET score was -2.5 points (95% CI, -9.2 to 4.1), and that in knee pain after exercise was -0.1 points (95% CI, -0.9 to 0.7). There was no significant difference between groups in the need for subsequent knee surgery or in the occurrence of serious adverse events.

By Adrienne Cheung

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