Changing practice: incidence of non‐reconstructive arthroscopic knee surgery in people over 50 years of age, Australia, 2008–2018

Lee, So Mang Simon; Awal, Wasim; Vertullo, Christopher J.

doi:10.5694/mja2.50436

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…Although the rate of knee arthroscopies in the aged population and in OA has been declining in Australia and the US, especially since the Medicare program stopped reimbursing physicians for arthroscopies performed for knee OA in 2004, whether such a decline occurs in OA patients with meniscus tears or elsewhere in the world is not known. 6 24 …”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Partial Meniscectomy versus Physical Therapy for Degenerative Meniscal Tear: a Systematic Review

et al. 2021

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Background Meniscal tears are commonly observed in patients with knee osteoarthritis (OA), however, clinical significance of such lesions detected by magnetic resonance imaging is in many cases unclear. This study aimed to determine the clinical effectiveness of arthroscopic partial meniscectomy (APM) compared with non-operative care in patients with knee OA. Method We used existing systematic reviews with updates of latest studies. Three randomized controlled studies were selected, where two studies compared the effects of APM plus physical therapy (PT) with PT alone and one compared APM alone and PT alone. While 1 study exclusively included OA patients, 2 studies included 21.1 and 12% of patients with no radiographic OA. Patients with knee locking were unanimously excluded. Results Upon comparison of APM plus PT and PT alone, there was no significant difference observed in knee function, physical activity, or adverse events. Knee pain was observed to be significantly lower in the APM plus PT group at 6 months, but there was no difference between the two groups at 12 and 24 months. With respect to the comparison between APM alone and PT alone, PT was non-inferior based on the criteria for knee function during 24 months; however, knee pain was significantly reduced in the APM alone group. Conclusions Our study showed that knee pain was significantly improved in the APM group compared to non-operative care group at 6 months and over 24 months. Our result was based on only 3 randomized controlled trials (RCTs) revealing a significant knowledge gap, hence demanding more high-quality RCTs in OA patients. Trial Registration PROSPERO Identifier: CRD42020215965

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Partial Meniscectomy versus Physical Therapy for Degenerative Meniscal Tear: a Systematic Review

et al. 2021

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“…Other studies from around the world have demonstrated similar changes to this study. Lee et al 18 in 2019 demonstrated similar findings when they reported on the Australian national trends of arthroscopy rates in patients over the age of 50 years. Essilfie et al in their large private insurance database study from the United States also demonstrated a significant decrease in the number of arthroscopic partial meniscectomies from 2010 to 2015.…”

Section: Discussionmentioning

confidence: 61%

Surgeons respond to growing evidence by performing less knee arthroscopic surgery in older patients

Donaldson

Doma

Parkinson

2021

ANZ Journal of Surgery

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Background: Recent research has shown that knee arthroscopy does not provide a meaningful clinical benefit for degenerative knee changes in the older population. The 2016 Australian Orthopaedic Association (AOA) Annual Scientific Meeting held a plenary session on this topic to educate surgeons about these research findings and communicate their clinical practice statement on this issue. This paper set out to find if there has been a change in clinical practice since this meeting. Methods: The analysis consisted of all knee arthroscopies performed in a single city of Far North Queensland, Australia, over an 8-year period. The number and type of arthroscopies performed in patients <50 and ≥50 years of age was compared before and after the 2016 AOA plenary session. Results: After the 2016 AOA educational session, there was a significant reduction in the number of debridement procedures performed in patients aged 50 years or older (275 vs. 142 per year, P < 0.01) but not in patients under 50 years of age (192 vs. 135 per year, P = 0.91). The annual number of repair procedures for all ages combined, increased from 11 per year to 60 per year (P < 0.01). Conclusion:The surgeons of this city have changed their knee arthroscopy clinical practice in line with the evidence and advice from their professional body.

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“… 17 The impact of these data on surgical practices is illustrated by the 39% decrease in recent years in arthroscopic knee surgery among Australian patients aged >50 years. 16 It has also been postulated that knee MRI early in the disease course for middle-aged and older patients may reveal meniscal lesions and subsequently increase the likelihood of arthroscopic surgery irrespective of the relevance of the lesion. 17 Our study showed a significantly lower incidence of surgery after MRI for older patients, which is appropriate given the documented little benefit of arthroscopic surgery in older patients, despite that there may have been lesions of surgical temptation on those scans.…”

Section: Discussionmentioning

confidence: 99%

Incidence Rates of Surgery After Knee MRI: Association According to Referring Physician Type and Patient’s Age and Sex

Naqvi

Beavis

Mondal

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The utility of magnetic resonance imaging (MRI) in the primary care setting is uncertain, with a perception that there is less likelihood for surgery after MRI ordered by general practitioners (GPs) when compared with orthopaedic surgeons and sports medicine physicians. Additionally, the influence of patient age and sex on subsequent surgical intervention is currently unknown. Purpose/Hypothesis: The purpose of this study was to compare surgical incidence after MRI referrals by orthopaedic surgeons, GPs, and sports medicine physicians, including a subset analysis for GP patients based on type of approval given by the radiologist. The authors also wanted to explore the association of age and sex on subsequent surgical intervention. They hypothesized that surgical incidence after MRI ordered by orthopaedic surgeons and sports medicine physicians would be higher than after MRI ordered by GPs. Study Design: Cohort study; Level of evidence, 3. Methods: Knee MRI referrals by the 3 physician cohorts during May to December 2017 were assessed. For GP patients, the types of approval or recommendation from a radiologist were categorized. Subsequent surgical intervention status was then compared among referral groups up to 2 years after MRI. Associations of age and sex with surgical occurrence were also assessed. Chi-square test, analysis of variance, and univariate/multivariable logistic regression were used for statistical analysis. Results: Overall, 407 referrals were evaluated (GP, n = 173; orthopaedic, n = 176; sports medicine, n = 58). Surgical incidence was not significantly higher for orthopaedic and sports medicine than GP referrals at 3 months (10%, 3%, and 6%, respectively; P = .23), 6 months (20%, 17%, and 15%; P = .49), and 2 years (30%, 35%, and 24%; P = .25). Surgical incidence for GP patients was higher after discussion with a radiologist or when evaluating specific pathology on prior imaging versus less defined reasons (30.4% vs 15.7%, respectively; P = .03). Surgical incidence was lower for older patients (11% vs 31% for >60 years vs all other age groups combined; P = .002), and women were less likely to undergo surgery than men (22% vs 35%, respectively; P = .008). Conclusion: Surgical incidence after MRI was likely appropriately lower for older patients. Lower incidence for female patients is of uncertain cause and warrants further study.

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Changing practice: incidence of non‐reconstructive arthroscopic knee surgery in people over 50 years of age, Australia, 2008–2018

Cited by 6 publications

References 6 publications

Arthroscopic Partial Meniscectomy versus Physical Therapy for Degenerative Meniscal Tear: a Systematic Review

Arthroscopic Partial Meniscectomy versus Physical Therapy for Degenerative Meniscal Tear: a Systematic Review

Surgeons respond to growing evidence by performing less knee arthroscopic surgery in older patients

Incidence Rates of Surgery After Knee MRI: Association According to Referring Physician Type and Patient’s Age and Sex

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