Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.
Level 2 - randomized trial
Multicenter randomized, double-blind, sham-controlled clinical trial.
PubMed 24369076 · doi:10.1056/NEJMoa1305189
What was done
A multicenter, randomized, double-blind, sham-controlled trial evaluated 146 patients aged 35 to 65 years with knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Participants were randomly assigned to arthroscopic partial meniscectomy or sham surgery. Primary outcomes at 12 months were changes in Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (both 0 to 100) and knee pain after exercise (0 to 10 scale).
What was found
In the intention-to-treat analysis, there were no significant between-group differences at 12 months in any primary outcome. Mean improvements in the partial-meniscectomy versus sham-surgery groups were: Lysholm score, 21.7 versus 23.3 points (between-group difference, -1.6 points; 95% CI, -7.2 to 4.0); WOMET score, 24.6 versus 27.1 points (between-group difference, -2.5 points; 95% CI, -9.2 to 4.1); and knee pain after exercise, 3.1 versus 3.3 points (between-group difference, -0.1 points; 95% CI, -0.9 to 0.7). Subsequent knee surgery occurred in two partial-meniscectomy patients and five sham-surgery patients; serious adverse events occurred in one and zero patients, respectively.
Why it matters
This trial provides strong evidence that arthroscopic partial meniscectomy offers no clinical benefit over sham surgery for degenerative medial meniscus tears in knees without osteoarthritis, challenging a widely performed procedure.
Limits
The study excluded patients with knee osteoarthritis and was limited to degenerative medial meniscus tears in adults aged 35 to 65, so findings cannot be generalized to lateral tears, traumatic tears, or older/younger populations. The sample size was 146 patients, and reported outcomes in the abstract are limited to 12 months of follow-up.
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- context A New England Journal of Medicine study comparing knee surgery to a sham incision procedure found no difference in clinical outcomes between the two groups.