Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.
Sihvonen R, Paavola M, Malmivaara A, et al. The New England journal of medicine 2013 · PMID 24369076 · doi:10.1056/nejmoa1305189
- Question
- In middle-aged patients with a degenerative medial meniscal tear and no knee osteoarthritis, is arthroscopic partial meniscectomy better than sham surgery?
- Design
- Multicentre, double-blind, sham-controlled RCT in Finland (Finnish Degenerative Meniscal Lesion Study).
- Patients
- 146 adults aged 35-65 with knee symptoms consistent with a degenerative medial meniscal tear and no established osteoarthritis.
- Intervention
- Arthroscopic partial meniscectomy
- Comparison
- Diagnostic arthroscopy with simulated (sham) meniscectomy
- Primary outcome
- Lysholm score, WOMET score and knee pain after exercise at 12 months
- Key result
- Both groups improved, with no significant difference between partial meniscectomy and sham surgery for any primary outcome at 12 months, and no significant difference in subsequent knee surgery or serious adverse events.
- Limitations
- Strict inclusion criteria excluded patients with osteoarthritis or traumatic tears, so findings do not apply to young patients with acute traumatic or locked knees.
- Impact on practice
- Key evidence that arthroscopic partial meniscectomy should not be routinely performed for degenerative meniscal tears; underpins UK guidance against arthroscopy for degenerate knees.