Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear : A secondary analysis of a randomized trial
Sihvonen, Raine ; Englund, Martin LU
; Turkiewicz, Aleksandra
LU
and Järvinen, Teppo L N
(2016)
In Annals of Internal Medicine
164(7).
p.449-455
- Abstract
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... (More)
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.
(Less)
- author
- Sihvonen, Raine
; Englund, Martin
LU
; Turkiewicz, Aleksandra
LU
and Järvinen, Teppo L N
- organization
- publishing date
- 2016-04-05
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Annals of Internal Medicine
- volume
- 164
- issue
- 7
- pages
- 7 pages
- publisher
- American College of Physicians
- external identifiers
-
- pmid:26856620
- wos:000373625300006
- scopus:84962627811
- ISSN
- 0003-4819
- DOI
- 10.7326/M15-0899
- language
- English
- LU publication?
- yes
- id
- 6b7113ec-31ad-4325-a60c-a36d84e79846
- date added to LUP
- 2016-06-02 15:51:19
- date last changed
- 2024-04-05 00:18:28
@article{6b7113ec-31ad-4325-a60c-a36d84e79846,
abstract = {{<p>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.</p>}},
author = {{Sihvonen, Raine and Englund, Martin and Turkiewicz, Aleksandra and Järvinen, Teppo L N}},
issn = {{0003-4819}},
language = {{eng}},
month = {{04}},
number = {{7}},
pages = {{449--455}},
publisher = {{American College of Physicians}},
series = {{Annals of Internal Medicine}},
title = {{Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear : A secondary analysis of a randomized trial}},
url = {{http://dx.doi.org/10.7326/M15-0899}},
doi = {{10.7326/M15-0899}},
volume = {{164}},
year = {{2016}},
}