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Sham surgery offers same results for meniscus tear

Arthroscopic partial meniscectomy were no better than those after a sham surgical procedure

A meniscus tear is a common knee injury. The meniscus is a rubbery, C-shaped disc that cushions your knee. Each knee has two menisci (plural of meniscus)-one at the outer edge of the knee and one at the inner edge. The menisci keep your knee steady by balancing your weight across the knee. A torn meniscus can prevent your knee from working right, according to WebMD.

Surgical repair may be done by open surgery, in which a small incision is made and the knee is opened up so that the surgeon can see inside the knee and the meniscus can be repaired. Increasingly, surgeons use arthroscopic surgery to repair the meniscus.

Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.

In this new study Dr. Teppo Jarvinen, MD, PhD, department of orthopedics and traumatology at Helsinki University Central Hospital in Finland, and colleagues conducted a multicenter, randomized, double-blind, sham-controlled trial involving 146 patients, aged 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis.

Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery, 70 patients had some of their damaged meniscus removed, while 76 other patients had sham surgery.

Surgeons performing the e sham surgery attempted to make everything look like a real procedure including asking for the same instruments and moved and pressed the knee. Mechanical instruments without the blades had been used to replicate the appearance and noises of a meniscal repair. Both procedures were timed so that one was not longer than the other.

The results showed in the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcomes.

The improvements in primary outcomes were as follows; The Lysholm score (activities of daily living) was 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group.

The score for knee pain after exercise was 3.1 for the surgery group and 3.3 for the sham group.

There were no significant differences between groups in the number of patients who required subsequent knee surgery (two in the partial-meniscectomy group and five in the sham-surgery group) or serious adverse events (one and zero, respectively).

In their conclusion the researchers write” In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.”

Dr. David T. Felson, Professor of Medicine and Public Health and Principal Investigator of the NIH-funded Boston University Multipurpose Arthritis and Musculoskeletal Diseases Center and the Boston University Multidisciplinary Research Center and not part of this study commented "There have been several trials now, including this one, where surgeons have examined whether meniscal tear surgery accomplishes anything, basically, and the answer through all those studies is no, it doesn't.”

Dr. Teppo Jarvinen remarked "I'm expecting a roar from the orthopedic community. This is the most common orthopedic procedure.” "I don't expect people to be happy about somebody showing that the stuff that they had been doing isn't any better than a sham procedure, but what can I do? That's the evidence.”

However, Dr. Felson did say meniscal repairs might still be useful for people who suddenly injure their knees, like those who play sports. But, for those with knee pain that comes on gradually and lingers without relief, medical treatment with physical therapy and anti-inflammatory medication appears to be the best option.

"I think that's what you do," he said.

This study is published in the New England Journal of Medicine.

Citation

Associated Slideshow; Meniscal tear and Non-surgical Options