Arthroscopy does not cure mechanical symptoms associated with degenerative knee
A new Finnish study has indicated that a commonly used arthroscopic technique does not help patients who suffer from sensations of knee catching or locking associated with a degenerative knee.
Although arthroscopic surgery on degenerative knees, or knee joints afflicted with age-related deterioration, has not been shown to be any more effective in alleviating mechanical symptoms than physical therapy or sham surgery, nevertheless partial meniscectomy has been common practice for practically all cases in which a patient with knee problems has reported symptoms knee catching or locking to the surgeon.
In a new study, published in Annals of Internal Medicine, the Finnish FIDELITY research group used results from a previous multicentre trial to determine whether partial meniscectomy had an impact on the prevalence of the mechanical symptom and whether the procedure results could alleviate the symptoms.
The group studied a total of 146 patients, all of them suffering for more than three months from pain in the inner side of the knee which had been deemed attributable to/resulting from a tear of the medial meniscus through clinical examination and MRI. Arthritic patients and patients whose symptoms began after an isolated significant trauma were excluded from the study. All patients underwent diagnostic keyhole surgery, and if a torn meniscus was found, the patients were randomised to undergo either partial meniscectomy (70 patients) or sham surgery (76 patients).
Thirty-two patients (46 per cent) in the partial meniscectomy group and 37 (49 per cent) in the placebo group initially (before surgery) reported sensations of mechanical symptoms. A follow-up survey was conducted after two, six and twelve months from the procedure. From the total of 146 patients, 34 (49 per cent) from the partial meniscectomy group and 33 (43 per cent) from the placebo group reported a mechanical symptom at some point during the follow-up process. Of the 69 patients who had mechanical symptoms at the outset, 23 (72 per cent) of the partial meniscectomy group and 22 (59 per cent) of the placebo group reported still experiencing mechanical symptoms at some point during the follow-up process. The mechanical symptoms were alleviated for the full duration of the follow-up process for nine patients (28 per cent) who underwent a partial meniscectomy and 15 patients (41 per cent) who underwent sham surgery.
“Based on these results we can state that the partial removal of a degenerative torn meniscus does not reduce or alleviate mechanical symptoms when compared with sham surgery,” said Teppo Järvinen, professor of orthopaedics and traumatology at the University of Helsinki and HUCS, who ran the study.
“Orthopaedists are largely unanimous on the benefits of arthroscopic surgery on patients suffering from mechanical symptoms; however, scientific proof of the benefits is scarce, and before our study, entirely based on uncontrolled follow-up studies,” added Raine Sihvonen, specialist in orthopaedics at the Hatanpää Hospital in Tampere and investigator in charge of the practical execution of the study.
The researchers emphasised that degenerative and traumatic meniscal tearing are two completely different illnesses, and should also be treated differently.
“Research indicates that treatment of a torn meniscus which is obviously traumatic in origin in a patient under 35 years of age seems to alleviate mechanical symptoms. In a degenerative knee, seemingly similar symptoms may not even be caused by the meniscal tear – more likely they are a reflection of the overall deterioration of the knee and prone to increase as arthritis develops further,” explained Järvinen.
Source: University of Helsinki
Reference: Sihvonen, R., Englund, M., Turkiewicz, A. & Järvinen, T.L.N. (2016) Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear. Annals Internal Med. doi: 10.7326/M15-0899