Arthroscopic partial meniscectomy in middle-aged patients with mild or no knee osteoarthritis: a protocol for a double-blind, randomized sham-controlled multi-centre trial

Abstract

BackgroundArthroscopic partial meniscectomy has been shown to be of no benefit to patients with concomitant knee osteoarthritis, but the optimal treatment of a degenerative meniscus tear in patients with mild or no knee osteoarthritis is unknown. This article describes the rationale and methodology of a randomized sham-controlled trial to assess the benefit of arthroscopic partial meniscectomy of a medial meniscus tear in patients with mild or no knee osteoarthritis. The objective of the study is to test whether the benefit from arthroscopic partial meniscectomy in patients with knee pain, medial meniscus lesion and mild/no knee osteoarthritis, is greater after arthroscopic partial meniscectomy than following sham surgery.MethodsWe will conduct a randomized controlled trial of treatment for degenerative meniscus tears in middle-aged patients (aged 35–55 years) with an MRI-verified medial meniscus lesion and mild or no knee radiographic osteoarthritis (grade 0–2 on the Kellgren & Lawrence scale). Patients will be randomized to receive either conventional arthroscopic partial meniscectomy or a sham surgery procedure. The primary outcome will be the KOOS5 derived from the ‘Knee Injury and Osteoarthritis Outcome Score’ at 2 years follow-up. Secondary outcomes at 2 years will include all five individual subscales of the KOOS, a global perceived effect score, the Short-Form-36 health status score, EQ-5D for economic appraisal and objective tests of muscle strength and physical function. Radiographic knee osteoarthritis will be evaluated at 5 years.DiscussionDemonstration of no additional benefit from arthroscopic partial meniscectomy on pain and function should lead to a change in clinical care of patients with a degenerative meniscus tear. The results of this study will provide empirical evidence for the potential benefit/harm of arthroscopic partial meniscectomy compared to a masked sham-therapeutics intervention.Trial registrationNCT01264991

Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear

“…34 Previous cohort studies have suggested that progression of osteoarthritis may be more rapid in persons who have undergone arthroscopic partial meniscectomy 35,36 ; it is uncertain whether this is an effect of the surgery. 37 Longterm follow-up of patients in the present trial and in other trials 8,38 is needed to address this question.…”

Sham surgery: justified but practical? A systematic review of sham surgery trials in orthopaedics

“…35 Roos et al received funding in 2010 to compare arthroscopic partial meniscectomy to sham surgery for degenerative meniscus tears. In 2013 they published a protocol paper 36 and in 2014 they published a paper describing their experiences with recruitment. 16 In all, 43% of eligible candidates agreed to participate.…”

Análisis de técnicas artroscópicas y osteotomía tibial alta en gonartrosis primaria

“…El desgarro de menisco en pacientes con GP está asociado a lesiones preexistentes en la estructura y composición del menisco lesionado, las fuerzas de estrés y los cambios degenerativos en la matriz de colágeno del mismo disminuyen considerablemente su capacidad tensil, lo que predispone al menisco a traumatismos aún de baja energía o de forma espontánea al realizar alguna actividad física que requiera poca demanda mecánica [20][21][22] . Una vez que se presenta la lesión de menisco asociada a cambios degenerativos de la articulación es necesario la resección del tejido meniscal lesionado, por lo que aumentan las cargas biomecánicas de la articulación y favorece el avance de la enfermedad degenerativa articular [23][24][25] .…”