"Arthroscopic Partial Meniscectomy versus
Sham Surgery for a Degenerative Meniscal Tear"

December 26th, 2013 Issue of The New England Journal of Medicine
Raine Sihvonen, M.D., Mika Paavola, M.D., Ph.D., Antti Malmivaara, M.D., Ph.D.,
Ari Itälä, M.D., Ph.D., Antti Joukainen, M.D., Ph.D., Heikki Nurmi, M.D.,
Juha Kalske, M.D., and Teppo L.N. Järvinen, M.D., Ph.D.
for the Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group

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

Methods
We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 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. The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100, with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure.

Results
In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, −1.6 points; 95% confidence interval [CI], −7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, −2.5 points; 95% CI, −9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, −0.1; 95% CI, −0.9 to 0.7). 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).

Conclusions
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. (Funded by the Sigrid Juselius Foundation and others; ClinicalTrials.gov number, NCT00549172.)

Supported by grants from the Sigrid Juselius Foundation, the Competitive Research Fund of Pirkanmaa Hospital District, and the Academy of Finland.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

We thank Heini Huhtala and Seppo Sarna for their help with the statistical analyses; Gordon Guyatt for his help with blinded data interpretation; research coordinator Pirjo Toivonen for her role in the implementation of the trial; research nurses Saara-Maija Hinkkanen, Marja-Liisa Sutinen, Pekka Karppi, Johanna Koivistoinen, and Sari Karesvuori for their assistance; Kari Tikkinen and Ghassan Alami for their critical comments on the manuscript; and Virginia Mattila for linguistic expertise and language revisions.

Source Information
From the Department of Orthopedics and Traumatology, Hatanpää City Hospital, Tampere (R.S.), the Department of Orthopedics and Traumatology, Helsinki University Central Hospital and University of Helsinki (M.P., J.K., T.L.N.J.), and the National Institute for Health and Welfare, Center for Health and Social Economics (A.M.), Helsinki, the Department of Orthopedics and Traumatology, University of Turku, Turku (A.I.), the Department of Orthopedics, Traumatology, and Hand Surgery, Kuopio University Hospital, Kuopio (A.J.), and the Department of Orthopedics and Traumatology, Central Finland Central Hospital, Jyväskylä (H.N.) — all in Finland.

Address reprint requests to Dr. Järvinen at the Department of Orthopedics and Traumatology, Helsinki University Central Hospital/Töölö Hospital, Topeliuksenkatu 5, P.O. Box 266, 00029 HUS, Helsinki, Finland, or at teppo.jarvinen@helsinki.fi.

A list of additional members of the FIDELITY Group is provided in the Supplementary Appendix, available at NEJM.org.
 

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