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

Abstract

Background: Arthroscopic meniscal surgery is a common orthopaedic procedure in middle-aged patients, but the efficacy of this procedure has been questioned. In this study, we followed up the only randomized controlled trial that has shown a 1-year benefit from knee arthroscopic surgery with an exercise program compared with an exercise program alone. Purpose: To (1) evaluate whether knee arthroscopic surgery combined with an exercise program provided an additional 5-year benefit compared with an exercise program alone in middle-aged patients with meniscal symptoms, (2) determine whether baseline mechanical symptoms affected the outcome, and (3) compare radiographic changes between treatment groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to either a 3-month exercise program (nonsurgery group) or to the same exercise program plus knee arthroscopic surgery (surgery group) within 4 weeks. Radiographs were assessed, according to the Kellgren-Lawrence grade, at baseline and at the 5-year follow-up. The primary outcome was the change in Knee injury and Osteoarthritis Outcome Score (KOOS)–Pain (KOOSPAIN) subscore from baseline to the 5-year follow-up. We performed an as-treated analysis. Results: A total of 102 patients completed the 5-year questionnaire. At the 5-year follow-up, both groups had significant improvement in KOOSPAIN subscores, although there was no significant change from the 3-year scores. There was no between-group difference in the change in the KOOSPAIN subscore from baseline to 5 years (3.2 points [95% CI, –6.1 to 12.4]; adjusted P = .403). In the surgery group, improvement was greater in patients without mechanical symptoms than in those with mechanical symptoms (mean difference, 18.4 points [95% CI, 8.7 to 28.1]; P < .001). Radiographic deterioration occurred in 60% of patients in the surgery group and 37% of those in the nonsurgery group ( P = .060). Conclusion: Knee arthroscopic surgery combined with an exercise program provided no additional long-term benefit after 5 years compared with the exercise program alone in middle-aged patients with meniscal symptoms. Surgical outcomes were better in patients without mechanical symptoms than in patients with mechanical symptoms during the preoperative period. Radiographic changes did not differ between treatment groups. Registration: NCT01288768 ( ClinicalTrials.gov identifier).

Arthroscopic partial meniscectomy: did it ever work?

“…In other words, patients having undergone APM had higher risk for OA development and progression (Sihvonen et al 2020 ). A similar finding was reported by Sonesson et al ( 2020 ) among patients randomized to APM or nonoperative treatment. Registry data from England showed that patients who had undergone an APM had a 2–3 times higher risk of total knee replacement compared with the general population (Abram et al 2019a ).…”

“…In their RCT, Gauffin et al ( 2014 ) reported that arthroscopic surgery provided better pain relief compared with nonoperative treatment at 1 year follow-up in people with meniscal symptoms. In a follow-up study, the trialists found that positive effects of surgery had diminished at 3- and 5-years’ follow-up and radiologic deterioration had become more common in the surgery group (Gauffin et al 2017 , Sonesson et al 2020 ).…”

Association Between Baseline Meniscal Symptoms and Outcomes of Operative and Nonoperative Treatment of Meniscal Tear in Patients With Osteoarthritis

“…However, the 3-year as-treated data also found that participants with meniscal symptoms had less improvement in KOOS pain score with APM. The 5-year follow-up data from this study again demonstrated a statistically significant greater reduction in KOOS pain score for those without meniscal symptoms in the APM group (20). As noted by Gauffin et al, meniscal symptoms may be nonspecific and not necessarily reflect meniscal pathology (18).…”

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

“…Another recently published 5 year follow-up of a randomised trial reported radiographic deterioration in 60% of patients in the surgery group and 37% in the non-surgery group (p=0.060). 32 However, all this evidence is subject to considerable uncertainties, as the observational data are prone to confounding by indication while the trial data 30 32 are hampered by high rates of crossover (around 25–30%) from non-operative treatment to surgery during the follow-up and high loss to follow-up (around 30%).…”