Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial

Abstract

ObjectivesTo assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at 5 years follow-up.DesignMulticentre, randomised, participant- and outcome assessor-blinded, placebo-surgery controlled trial.SettingOrthopaedic departments in five public hospitals in Finland.Participants146 adults, mean age 52 years (range 35–65 years), with knee symptoms consistent with degenerative medial meniscus tear verified by MRI scan and arthroscopically, and no clinical signs of knee osteoarthritis were randomised.InterventionsAPM or placebo surgery (diagnostic knee arthroscopy).Main outcome measuresWe used two indices of radiographic knee osteoarthritis (increase in Kellgren and Lawrence grade ≥1, and increase in Osteoarthritis Research Society International (OARSI) atlas radiographic joint space narrowing and osteophyte sum score, respectively), and three validated patient-relevant measures of knee symptoms and function (Western Ontario Meniscal Evaluation Tool (WOMET), Lysholm, and knee pain after exercise using a numerical rating scale).ResultsThere was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the APM group as compared with the placebo surgery group (adjusted absolute risk difference in increase in Kellgren-Lawrence grade ≥1 of 13%, 95% CI −2% to 28%; adjusted absolute mean difference in OARSI sum score 0.7, 95% CI 0.1 to 1.3). There were no relevant between-group differences in the three patient-reported outcomes: adjusted absolute mean differences (APM vs placebo surgery), −1.7 (95% CI −7.7 to 4.3) in WOMET, −2.1 (95% CI −6.8 to 2.6) in Lysholm knee score, and −0.04 (95% CI −0.81 to 0.72) in knee pain after exercise, respectively. The corresponding adjusted absolute risk difference in the presence of mechanical symptoms was 18% (95% CI 5% to 31%); there were more symptoms reported in the APM group. All other secondary outcomes comparisons were similar.ConclusionsAPM was associated with a slightly increased risk of developing radiographic knee osteoarthritis and no concomitant benefit in patient-relevant outcomes, at 5 years after surgery.Trial registrationClinicalTrials.gov (NCT01052233 and NCT00549172).

Knee arthroscopy: evidence for a targeted approach

“…An editorial by Engebretsen and Moatshe 4 in the same edition provides a more balanced discussion on the 5-year results of the Finnish Degenerative Meniscus Lesion Study (FIDELITY) trial also published in the same issue. 5 This editorial contends that the conclusion by Sihvonen and colleagues that arthroscopic partial meniscectomy is associated with a greater risk of osteoarthritis is too strong for the data presented. 4 They also point out that patients with an obvious traumatic onset or a recent locked knee were excluded, thus not representing the wider population of patients undergoing arthroscopy.…”

Meniscal repair: The current state and recent advances in augmentation

“…Degenerative tears are often observed with other articular pathologies or are within aging joints that complicate the healing process and reduce the possibility of successful repair 137,138 . Typically treated conservatively first with physical therapy and, as a last resort, with partial meniscectomy, 139‐141 the long‐term prognosis of these injuries is bleak. Additionally, degenerative menisci have likely experienced significant matrix loss and aberrant cellular behavior; thus, to save the meniscus in these case, fortification and stabilization techniques 142,143 may better restore healthy meniscus function when combined with repair.…”

Peeling off musculoskeletal labels: sticks and stones may break my bones, but diagnostic labels can hamstring me forever

“…Each person interprets each label differently—many labels have negative connotations. If a diagnostic MRI in a person with knee pain describes a meniscal tear , this may nudge the patient (and clinician) to prioritise options such as arthroscopic surgery 5 that are not indicated as first-line therapy.…”