A commonly performed knee procedure, known as partial meniscectomy, may not provide the benefits that many patients anticipate. A significant study with a decade-long follow-up has found that cutting away a damaged meniscus does not lead to improved symptoms or knee function when compared to a placebo procedure.
Partial meniscectomy ranks among the most frequently conducted orthopedic surgeries globally. Although its application has decreased in Finland in recent years, it continues to be a standard treatment in various other countries.
10-Year Study Reveals Poorer Outcomes Following Surgery
The long-term findings are rather troubling. Patients who underwent partial meniscectomy did not have better outcomes than those who received sham surgery; in fact, their results were generally worse.
After ten years, these individuals reported more knee issues and diminished function. Furthermore, they exhibited more advanced osteoarthritis and were more likely to require additional knee surgeries compared to those who did not undergo the actual procedure.
Unique Trial Design Enhances Findings
The Finnish Degenerative Meniscal Lesion Study (FIDELITY) is notable for its rigorous methodology. It incorporated a sham surgery control group, enabling a direct comparison of outcomes against a placebo procedure. Participants with degenerative meniscal tears were randomly assigned to either partial meniscectomy or sham surgery, with their progress tracked for ten years.
Teppo Järvinen, a Professor at the University of Helsinki and the principal investigator of FIDELITY, highlights the broader implications of the findings:
“Our results suggest that this may exemplify what’s termed a medical reversal, where a widely used treatment turns out to be ineffective or even detrimental.”
Rethinking the Origin of Knee Pain
The surgery has long been premised on the belief that knee pain, particularly on the inner side, stems from a meniscus tear that can be surgically repaired. However, this assumption might not be accurate.
“The surgery hinges on the idea that pain on the inside of the knee is caused by a medial meniscus tear that can be surgically addressed. This reasoning—rooted in biological credibility—is still prevalent in medicine, but in this case, it doesn’t hold up under scrutiny. Current understanding indicates that pain in various joints, including the knee, is linked to degeneration associated with aging,” states Raine Sihvonen, an Orthopaedics and Traumatology specialist and another principal investigator of the FIDELITY study.
Concerns About Risks and Long-Term Damage
Previous registry and observational studies have already pointed out potential drawbacks of this surgery. These include a higher chance of needing joint replacement surgery and an increased risk of complications post-procedure. However, observational data alone cannot establish definitive cause-and-effect relationships.
“Several randomized studies have shown that partial meniscectomy does not improve patients’ symptoms or function in the short (1-2 years) or medium (5 years) term. Nonetheless, the procedure continues to be widely practiced in many places,” notes Dr. Roope Kalske, a Doctoral Researcher and Orthopaedics and Traumatology specialist.
Reasons for Continued Use of the Procedure
Despite accumulating evidence, changing clinical practices has lagged.
“For nearly a decade, numerous independent, non-orthopedic organizations have recommended discontinuing this procedure. Still, institutions like the American Academy of Orthopedic Surgeons (AAOS) and the British Association for Surgery of the Knee (BASK) have retained their support for the surgery.
“This situation illustrates the considerable difficulty in abandoning ineffective therapies,” Järvinen summarizes.
Robust Collaboration Behind the Study
The research involved five hospitals, showcasing strong collaboration and patient engagement. Of the original 146 participants, over 90% completed the final follow-up.
“The study, undertaken across five hospitals, exemplifies excellent multicenter cooperation and the commitment of research participants to an intriguing project. Over 90% of the original 146 individuals took part in the final phase of the study,” remarked research manager Pirjo Toivonen.
The Finnish Degenerative Meniscal Lesion Study (FIDELITY) is part of the broader efforts by the FICEBO research group to evaluate the impact of surgical interventions. The project is a collaborative endeavor involving the university hospitals of Helsinki, Kuopio, and Turku, along with Hatanpää Hospital in Tampere, Hospital Nova in Jyväskylä, and the Finnish Institute for Health and Welfare.
