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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.

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author
organization
publishing date
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
  • 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
2016-11-14 10:22:42
@misc{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    = {ARRAY(0x8793748)},
  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},
  volume       = {164},
  year         = {2016},
}