Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial.
Ann Intern Med
; 164(7): 449-55, 2016 Apr 05.
Article
in En
| MEDLINE
| ID: mdl-26856620
ABSTRACT
BACKGROUND:
Recent evidence shows that arthroscopic partial meniscectomy (APM) offers no benefit over conservative treatment of patients with a degenerative meniscus tear. However, patients who report mechanical symptoms (sensations of knee catching or locking) may benefit from APM.OBJECTIVE:
To assess whether APM improves mechanical symptoms better than sham surgery.DESIGN:
Randomized, patient- and outcome assessor-blinded, sham surgery-controlled, multicenter trial. (ClinicalTrials.gov NCT00549172).SETTING:
5 orthopedic clinics in Finland. PATIENTS Adults (aged 35 to 65 years) with a degenerative medial meniscus tear and no knee osteoarthritis. INTERVENTION APM or sham surgery. MEASUREMENTS Patients' self-report of mechanical symptoms before surgery and at 2, 6, and 12 months after surgery.RESULTS:
70 patients were randomly assigned to APM, and 76 were assigned to sham surgery. Thirty-two patients (46%) in the APM group and 37 (49%) in the sham surgery group reported catching or locking before surgery; the corresponding numbers at any follow-up were 34 (49%) and 33 (43%), with a risk difference of 0.03 (95% CI, -0.06 to 0.12). In the subgroup of 69 patients with preoperative catching or locking, the risk difference was 0.07 (CI, -0.08 to 0.22).LIMITATION:
Analyses were post hoc, and the results are only generalizable to knee catching and occasional locking because few patients reported other types of mechanical symptoms.CONCLUSION:
Resection of a torn meniscus has no added benefit over sham surgery to relieve knee catching or occasional locking. These findings question whether mechanical symptoms are caused by a degenerative meniscus tear and prompt caution in using patients' self-report of these symptoms as an indication for APM. PRIMARY FUNDING SOURCE Academy of Finland.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Arthroscopy
/
Menisci, Tibial
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Tibial Meniscus Injuries
Type of study:
Clinical_trials
/
Diagnostic_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Ann Intern Med
Year:
2016
Type:
Article