Clinical Question

Does partial meniscectomy fix mechanical symptoms—knee catching or locking—better than sham surgery?

Bottom Line

Removing the torn bits of meniscus in middle-aged patients who have intermittent knee catches or locking does not decrease their likelihood of experiencing symptoms in the following year compared with diagnostic arthroscopy (i.e., looking but not touching). In general, meniscectomy does not improve knee pain, regardless of the symptoms (N Engl J Med. 2013;369(26):2515–2524). (Level of Evidence = 1b−)

Synopsis

This report is a substudy of a larger study investigating the effect of arthroscopic surgery on (relatively) young patients with meniscal tear but without signs of osteoarthritis. These Finnish investigators enrolled 146 patients, 35 to 65 years of age, who had knee pain for at least three months and evidence of a degenerative meniscal tear but did not respond to conservative treatment. They excluded patients with a verified locked knee (unable to straighten), although they included patients (n = 69) who had symptoms of catching or occasional or frequent locking. All patients underwent arthroscopic surgery, although slightly more than one-half were randomly assigned, using concealed allocation, to a group that did not have the tear addressed (sham surgery). In the surgery group, damaged and loose parts were removed; in the sham surgery group, diagnostic arthroscopy was performed, and the surgeon simulated actual surgery (because patients were awake) without removing anything. In the subsequent 12 months, 23 (72%) in the surgery group and 22 (59%) in the sham surgery group with preoperative mechanical symptoms reported symptoms at least once. Only nine of 32 patients (28%) in the surgery subgroup and 15 of 37 (41%) in the sham surgery subgroup reported complete resolution of their symptoms.

Study design: Randomized controlled trial (double-blinded)

Funding source: Foundation

Allocation: Concealed

Setting: Outpatient (specialty)

Reference: SihvonenREnglundMTurkiewiczAJärvinenTLFinnish Degenerative Meniscal Lesion Study GroupMechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear: a secondary analysis of a randomized trial. Ann Intern Med2016;164(7):449–455.