Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial.

BACKGROUND

Recent evidence shows that arthroscopic partial meniscectomy (APM) offers no benefit over conservative treatment of patients with a degenerative meniscus tear. However, patients who report mechanical symptoms (sensations of knee catching or locking) may benefit from APM.

OBJECTIVE

To assess whether APM improves mechanical symptoms better than sham surgery.

DESIGN

Randomized, patient- and outcome assessor-blinded, sham surgery-controlled, multicenter trial. (ClinicalTrials.gov: NCT00549172).

SETTING

5 orthopedic clinics in Finland.

PATIENTS: Adults (aged 35 to 65 years) with a degenerative medial meniscus tear and no knee osteoarthritis.

INTERVENTION: APM or sham surgery.

MEASUREMENTS: Patients' self-report of mechanical symptoms before surgery and at 2, 6, and 12 months after surgery.

RESULTS

70 patients were randomly assigned to APM, and 76 were assigned to sham surgery. Thirty-two patients (46%) in the APM group and 37 (49%) in the sham surgery group reported catching or locking before surgery; the corresponding numbers at any follow-up were 34 (49%) and 33 (43%), with a risk difference of 0.03 (95% CI, -0.06 to 0.12). In the subgroup of 69 patients with preoperative catching or locking, the risk difference was 0.07 (CI, -0.08 to 0.22).

LIMITATION: Analyses were post hoc, and the results are only generalizable to knee catching and occasional locking because few patients reported other types of mechanical symptoms.

CONCLUSION

Resection of a torn meniscus has no added benefit over sham surgery to relieve knee catching or occasional locking. These findings question whether mechanical symptoms are caused by a degenerative meniscus tear and prompt caution in using patients' self-report of these symptoms as an indication for APM.

PRIMARY FUNDING SOURCE: Academy of Finland.