Changes in rates of arthroscopy due to degenerative knee disease and traumatic meniscal tears in Finland and Sweden

Abstract

Background and purposeKnee arthroscopy is commonly performed to treat degenerative knee disease symptoms and traumatic meniscal tears. We evaluated whether the recent high-quality randomized control trials not favoring arthroscopic surgery for degenerative knee disease affected the procedure incidence and trends in Finland and Sweden.Patients and methodsWe conducted a bi-national registry-based study including all adult (aged ≥18 years) inpatient and outpatient arthroscopic surgeries performed for degenerative knee disease (osteoarthritis (OA) and degenerative meniscal tears) and traumatic meniscal tears in Finland between 1997 and 2012, and in Sweden between 2001 and 2012.ResultsIn Finland, the annual number of operations was 16,389 in 1997, reached 20,432 in 2007, and declined to 15,018 in 2012. In Sweden, the number of operations was 9,944 in 2001, reached 11,711 in 2008, and declined to 8,114 in 2012. The knee arthroscopy incidence for OA was 124 per 105 person-years in 2012 in Finland and it was 51 in Sweden. The incidence of knee arthroscopies for meniscal tears coded as traumatic steadily increased in Finland from 64 per 105 person-years in 1997 to 97 per 105 person-years in 2012, but not in Sweden.InterpretationThe incidence of arthroscopies for degenerative knee disease declined after 2008 in both countries. Remarkably, the incidence of arthroscopy for degenerative knee disease and traumatic meniscal tears is 2 to 4 times higher in Finland than in Sweden. Efficient implementation of new high-quality evidence in clinical practice could reduce the number of ineffective surgeries.

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

“…7,8,31,38 Consequently, the rates of arthroscopic meniscal procedures have declined in recent years. 34,36 Recently, a clinical guideline for degenerative knee disease and meniscal tears strongly recommended against arthroscopic surgery in nearly all patients with degenerative knee disease. 45 Therefore, nonsurgical treatment should be the first-line treatment 3,29 ; indeed, in the present study, prior physical therapy was an inclusion criterion.…”

Temporal trends and regional variation in the rate of arthroscopic knee surgery in England: analysis of over 1.7 million procedures between 1997 and 2017. Has practice changed in response to new evidence?

“…28 To 2012, rates of arthroscopic meniscal surgery in Finland were approximately 125 per 100 000; yet the same study found the equivalent rate in Sweden was less than 50 per 100 000. 29 In Canada, a rate of approximately 180 per 100 000 was reported in 2004. 30 In Australia, a relatively stable rate of knee arthroscopy was reported from 2001 to 2008 at just under 350 per 100 000.…”

“…The knee arthroscopy intervention rate varies considerably between countries and regional variation in similar procedures, such as shoulder arthroscopy, has been reported previously. [27][28][29][30][31][32] We aimed to determine the trend in the age and sexstandardised population intervention rate of arthroscopic knee surgery over a 20-year period from 1997 to 2017. Particular focus is given to the analysis of APM surgery, given the recently published evidence and because this is the most commonly performed procedure.…”

Editorial Commentary: Meniscal Tears or Meniscal Aging—That Is the Question

“…This seems to be in line with recently published data such as the national registries from Finland and Sweden, where the incidence of arthroscopies for degenerative knee disease significantly declined after 2008. 9 Khan et al 10 performed a systematic review with a meta-analysis concluding that there is moderate evidence to suggest that there is no benefit to arthroscopic meniscal debridement for degenerative meniscal tears in comparison with nonoperative or sham treatments in middle-aged patients with mild or no concomitant osteoarthritis and that a trial of nonoperative management should be the first-line treatment for such patients. More recently, van de Graaf et al 11 performed a multicenter, randomized clinical trial that was conducted in 9 hospitals.…”