Arthroscopic partial meniscectomy: did it ever work?

Abstract

Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT? A truly effective treatment needs a valid disease model that would biologically and plausibly explain the perceived treatment benefits. In the case of DMT, effectiveness requires a credible framework for the pain-generating process, which should be influenced by APM. Basic research, pathoanatomy, and clinical evidence gives no support to these frameworks. Moreover, treatment of DMT with an APM does not align with the traditional practice of medicine since DMT is not a reliable diagnosis for knee pain and no evidence-based indication exists that would influence patient prognosis from APM. A plausible and robust explanation supported by both basic research and clinical evidence is that DMTs are part of an osteoarthritic disease process and do not contribute to the symptoms independently or in isolation and that symptoms are not treatable with APM. This is further supported by the fact that APM as an intervention is paradoxical because the extent of procedure and severity of disease are both inversely associated with outcome. We argue that arthroscopic treatment of DMT is largely based on a logical fallacy: post hoc ergo propter hoc.

The Relationship Between the Timing of Knee Osteoarthritis Diagnoses and Arthroscopic Partial Meniscectomy

“…10,14,21,23,25-27 The rationale for APM is ultimately to treat knee pain, but research on the pathoanatomy of meniscus tears in degenerative knees does not support its biological role nor does compelling evidence demonstrating its efficacy in relieving pain exist. 28…”

"You're stuck in the middle here": A qualitative study of GPs' experiences of managing knee pain attributed to a degenerative meniscal tears

“…A DMT is different from an acute meniscal injury associated with acute trauma or sports injury. DMTs are usually considered atraumatic and often present spontaneously or after low-energy injuries (5).…”

Arthroscopic Meniscal Repair With Second-Generation Platelet-Rich Fibrin Clot Augmentation

“…Given this scientific evidence, meniscal repair is recommended, especially in younger individuals. [9][10][11] The success or failure of meniscal repair is highly influenced by factors such as tear location, pattern, chronicity, size, and extent; repair technique; and patient age and habits. 12,13 A recent meta-analysis by Xu and Zhao 14 concluded that better long-term outcomes are obtained after meniscal repair than after meniscectomy, but the reoperation rate is on the higher side.…”

“…Given this scientific evidence, meniscal repair is recommended, especially in younger individuals. 9 , 10 , 11 …”