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Rynecki ND, Charalambous L, Alaia MJ. Utilization of Knee Arthroscopy for Degenerative Meniscus Tears Is on the Decline Alongside Reimbursement Rates. Arthroscopy 2024:S0749-8063(24)00241-X. [PMID: 38518868 DOI: 10.1016/j.arthro.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
In recent years, there has been a shift in healthcare away from the fee-for-service model to a value-based care model. Concomitantly, there have been changes in inflation-adjusted surgeon reimbursements for arthroscopic meniscectomies. Nationally, albeit at different rates, there has been a decrease in partial meniscectomy utilization. We feel that this is in part due to the change in healthcare economics and reimbursements as well as the growing evidence that partial meniscectomy may not be as efficacious in the treatment of degenerative meniscus tears as we once thought.
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Ou Y, Xiong T, Li N, Liu S, Yi X, Deng X, Guo D, Chen S, Cheng T, Hao L. Knee arthroscopy has limited effects on relieving local symptoms of knee osteoarthritis: an analysis of data from the Osteoarthritis Initiative. Clin Rheumatol 2024; 43:443-451. [PMID: 37556004 DOI: 10.1007/s10067-023-06737-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Knee arthroscopy's efficacy in symptom improvement for knee osteoarthritis remains debated. In this study, we analyzed a multicenter database to investigate local symptom improvement. METHODS We extracted and analyzed the data of 163 patients from the Osteoarthritis Initiative cohort who underwent unilateral knee arthroscopy (UKA) and were followed up for at least 24 months. UKA patients were matched to non-UKA patients (n = 163) according to sex, age, abdominal circumference, and Kellgren-Lawrence grade. The verified KOOS questionnaires (knee catching, locking, grinding, or clicking) and common local symptoms (frequent knee pain, aching, or stiffness) were set as outcomes. Furthermore, we built a binary logistic regression model to examine the relationship between UKA and local symptom improvement and new-onset symptoms, adjusting for conservative therapeutic covariables (injection of steroids or transparent acid into the knee joint, oral chondroitin sulfate, amino glucose, or analgesics). RESULT Analysis showed that the UKA and non-UKA groups showed no obvious difference in the three knee symptoms, but the probability of new-onset grinding or clicking, and frequent knee pain, aching, or stiffness symptoms in the UKA group were respectively 5.82 and 5.65-fold higher than that in the non-UKA group. After analyzing conservative treatment data using a multiple imputation method, the results were consistent with previous regression analyses. CONCLUSION Compared to the non-UKA group, the UKA group showed no noticeable differences in the improvement of the three knee symptoms and showed an increased the probability of new-onset grinding or clicking and frequent knee pain, aching, or stiffness symptoms. Key Points • Knee arthroscopy may increase the probability of new-onset grinding or clicking and frequent knee pain, aching, or stiffness symptoms. • We found no difference in the improvement of local knee symptoms (knee catching, locking, grinding, clicking or frequent pain, aching, or stiffness) improvement between the two groups with or without knee arthroscopy.
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Affiliation(s)
- Yanghuan Ou
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Xiong
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Na Li
- School of Future Technology, Nanchang University, Nanchang, China
| | - Shuaigang Liu
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuan Yi
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xueqiang Deng
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Douhui Guo
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shenliang Chen
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Cheng
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Liang Hao
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, China.
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Park CM, Ryoo S, Choi M, Lee SJ, Yoo JJ, Kim HA. Total Knee Replacement After Arthroscopic Meniscectomy in Knee Osteoarthritis: A Nationwide Population-Based Cohort Study. J Korean Med Sci 2023; 38:e6. [PMID: 36593689 PMCID: PMC9807768 DOI: 10.3346/jkms.2023.38.e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recent studies raise concerns that arthroscopic meniscectomy (AM) for degenerative tear may be detrimental to the maintenance of the joint structure. This study was performed to examine the rate of total knee replacement (TKR) among patients with knee osteoarthritis (OA) who underwent AM for meniscal tears and compare this rate with those who did not. METHODS A retrospective cohort study was conducted using the National Health Insurance Database of South Korea. Among knee OA patients aged 50-79, those who were treated with AM due to meniscal damage from 2007 to 2009 were selected as the AM group while those not treated with AM despite the presence of meniscal damage were selected as control group. Both were matched based on a propensity score and followed-up until the earliest occurrence of: TKR, death, or 10 years. Cox proportional hazards models were used to compare the outcome. RESULTS A total of 36,974 patients were included in AM groups and non-AM group after 1:1 matching. TKR occurred in 9.62% and 7.64% in AM and non-AM groups with the average duration after meniscectomy of 5.88 ± 2.77 and 5.50 ± 2.94 years, respectively. After adjustment for baseline confounders, the TKR rate in the AM group was calculated to be 25% higher than that in the non-AM group (subdistribution hazard ratio, 1.25; 95% confidence interval, 1.16-1.34). The mortality rate was 5.20%, which did not significantly differ between groups. CONCLUSION OA patients who underwent AM for the meniscal injury had higher incidence of TKR up to 10 years of follow-up than the non-operated group. The greater TKR utilization observed in patients undergoing AM merits caution when treating OA patients with meniscal injury.
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Affiliation(s)
- Chan Mi Park
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Seungeun Ryoo
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Miyoung Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Su Jung Lee
- College of Nursing, Institute of Health Science Research, Inje University, Gimhae, Korea
| | - Jong Jin Yoo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Institute for Skeletal Aging, Hallym University, Chuncheon, Korea.
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Bisson LJ. Editorial Commentary: We Should Be Cautious About Using Catching and Locking as an Indication for Knee Arthroscopy: Mechanical Symptoms May Be Multifactorial in Their Causes. Arthroscopy 2023; 39:100-101. [PMID: 36543415 DOI: 10.1016/j.arthro.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/23/2022]
Abstract
Knee arthroscopy may be offered as a treatment for mechanical (catching/locking, grinding/clicking) and meniscal (pain with twisting/pivoting) symptoms. Recent studies have found that mechanical symptoms, particularly catching/locking, may be multifactorial in their causes (chondral lesions, meniscal tears, loose bodies) and less responsive to arthroscopic meniscectomy. Surgeons should be aware of this evidence and adjust their surgical indications appropriately.
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Sayegh ET, Farina EM, Lowenstein NA, Chang Y, Arant KR, Katz JN, Matzkin EG. Grinding, Clicking, and Pivot Pain Resolve in Most Patients After Knee Arthroscopy. Arthroscopy 2023; 39:91-99.e1. [PMID: 35840066 DOI: 10.1016/j.arthro.2022.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether knee arthroscopy alleviates the symptom constellation of knee grinding/clicking, catching/locking, and pivot pain. METHODS One-year follow-up data from 584 consecutive subjects who underwent knee arthroscopy from August 2012 to December 2019 were collected prospectively. Subjects reported frequency of knee grinding/clicking, catching/locking, and/or pivot pain preoperatively and 1 and 2 years postoperatively. A single surgeon performed each procedure and documented all intraoperative pathology. We measured the postoperative resolution or persistence of these symptoms and used multivariable regression models to identify preoperative demographic and clinical variables that predicted symptom persistence. We also assessed changes in the Pain, Activities of Daily Living, and Quality of Life subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS Postoperative symptom resolution was more likely for grinding/clicking (65.6%) and pivot pain (67.8%) than for catching/locking (44.1%). Smoking status, overweight/obesity, absence of meniscal tear, and number of compartments with focal cartilage lesions predicted persistence of 1 or more patient-reported knee symptoms. KOOS subscale scores consistently improved by at least one standard deviation. Individuals who had resolution of patient-reported knee symptoms exhibited roughly 2-fold improvements in KOOS Pain, ADL and Quality of Life scores compared with those whose symptoms persisted. Persistence of pivot pain was associated with the least improvement of the 3 KOOS subscales. CONCLUSIONS Two in three patients with grinding/clicking or pivot pain experience symptom resolution after knee arthroscopy, although catching/locking is more likely to persist. Smoking status, overweight/obesity, absence of meniscal tear, and number of compartments with focal cartilage lesions predict symptom persistence after knee arthroscopy. LEVEL OF EVIDENCE Therapeutic Level IV, retrospective cohort analysis of prospective data.
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Affiliation(s)
- Eli T Sayegh
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Evan M Farina
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Natalie A Lowenstein
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kaetlyn R Arant
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A..
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Chen W, Yang Y, Tang G. Mapping knowledge structure and research trends of knee osteoarthritis with meniscus in two decades: A bibliometric analysis. Front Surg 2022; 9:939003. [PMID: 36386528 PMCID: PMC9649907 DOI: 10.3389/fsurg.2022.939003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/27/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a chronic degenerative disease that is closely related to the meniscus. Currently, no bibliometric studies have jointly analyzed KOA and the meniscus. This study aimed to provide a comprehensive analysis of the knowledge structure of KOA and the meniscus across two decades and to identify the emerging research trends from a bibliometric perspective. METHODS All articles reporting KOA and the meniscus from 2001 to 2021 were obtained from the Web of Science Core Collection. R software, CiteSpace, VOS Viewer, and Microsoft Excel were used to analyze the publications including the authors, cited authors, journals, cited journals, country of research, institutions, and research focus. These data were used to generate visual knowledge maps of the outputs. RESULTS A total of 3,218 articles were retrieved. Guermazi was identified as the author who had contributed the most to the field and Osteoarthritis and Cartilage was identified as the most productive research journal. The United States is the global leader in the field and the center for international cooperation with less international collaboration occurring in Eastern Asia. Boston University was the most prolific institution. According to the data, "articular-cartilage," "meniscectomy," "follow-up," "anterior cruciate ligament," and "cartilage" were identified as research hotspots in the field. "Consequences," "prognostic-factors," and "receptor" were predicted as future hot topics of research. CONCLUSIONS This study is the first comprehensive bibliometric study to jointly analyze KOA and the meniscus. Our data enable a better understanding of research trends and identify research hotspots and gaps in knowledge across the field. Our findings provide practical information for researchers to better understand the key research areas and identify the research frontiers and future hot topics.
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Affiliation(s)
- Weijian Chen
- Graduate College, Guangxi University of Chinese Medicine, Nanning, China
- Department of Orthopedics, Guilin Hospital of Traditional Chinese Medicine, Guilin, China
| | - Yaqin Yang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Gangjian Tang
- Graduate College, Guangxi University of Chinese Medicine, Nanning, China
- Department of Orthopedics, Guilin Hospital of Traditional Chinese Medicine, Guilin, China
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McHugh C, Opare-Addo M, Collins J, Jones M, Selzer F, Losina E, Katz J. Treatment of the syndrome of knee pain and meniscal tear in middle-aged and older persons: A narrative review. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4. [PMID: 35991623 PMCID: PMC9384701 DOI: 10.1016/j.ocarto.2022.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective: Design: Results: Conclusion:
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McHugh CG, Matzkin EG, Katz JN. Mechanical symptoms and meniscal tear: a reappraisal. Osteoarthritis Cartilage 2022; 30:178-183. [PMID: 34600120 PMCID: PMC8792212 DOI: 10.1016/j.joca.2021.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify and summarize literature related to the association between mechanical symptoms (catching and locking of the knee), the presence of meniscal tear, and outcomes after arthroscopic surgery. DESIGN We searched PubMed and hand-searched reference lists for relevant articles and selected 38 for analysis. RESULTS Mechanical symptoms appear to have modest sensitivity (ranging 0.32-0.69), specificity (ranging 0.45-0.74) and positive predictive value (ranging 0.75-0.81) for meniscal tear. There is also very little evidence to suggest that those with mechanical symptoms experience better outcomes after arthroscopic surgery. CONCLUSION Our examination of the literature does not support the hypothesis that mechanical symptoms are related to the presence of meniscal tear or portend better outcomes after arthroscopic surgery.
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Affiliation(s)
| | - Elizabeth G. Matzkin
- Department of Orthopedic Surgery, Boston, MA USA,Brigham and Women’s Hospital; Harvard Medical School, Boston, MA USA
| | - Jeffrey N. Katz
- Department of Orthopedic Surgery, Boston, MA USA,Division of Rheumatology, Immunity and Inflammation, Boston, MA USA,Brigham and Women’s Hospital; Harvard Medical School, Boston, MA USA
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Isolated Arthroscopic Partial Meniscectomy Is More Effective at Improving Meniscal Symptoms in Comparison With Mechanical Symptoms in Patients With Concomitant Untreated Chondral Lesions. Arthroscopy 2022; 38:489-497.e17. [PMID: 34624500 DOI: 10.1016/j.arthro.2021.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To rank Knee Injury and Osteoarthritis Outcome Score (KOOS) questions from most to least improvement after arthroscopic partial meniscectomy (APM) and compare improvement of meniscal versus mechanical symptoms. METHODS A secondary analysis of the Chondral Lesions and Meniscus Procedures (ChAMP) Trial was performed. Inclusion criteria were age 30 years or older with degenerative meniscal tear failing nonoperative management, with or without associated unstable chondral lesions. No chondral debridement was performed. Responses to the 42 KOOS questions ranged from 0 (extreme problems) to 4 (no problems), and were answered preoperatively and at 1 year after isolated APM. The 1-year mean change, or delta (Δ), was calculated for each KOOS question and the Δ for meniscal and mechanical symptoms were statistically compared. RESULTS Greatest improvement in 135 eligible patients was observed for questions about (1) awareness of knee problems (Δ = 1.93, standard deviation [SD] = 1.38), (2) frequency of knee pain (Δ = 1.93, SD = 1.29), (3) degree of difficulty while twisting/pivoting on the injured knee (Δ = 1.88, SD = 1.13), (4) degree of difficulty while running (Δ = 1.67, SD = 1.30), and (5) being troubled by lack of confidence in the knee (Δ = 21.67, SD = 1.11). Least improvement was observed for questions about: (1) degree of difficulty while getting on/off the toilet (Δ = 0.94, SD = 0.96), (2) feel grinding or hear clicking when the knee moves (Δ= 0.90, SD = 1.25), 3) degree of difficulty while getting in/out of the bath (Δ= 0.88, SD = 1.00), (4) knee catches/hangs up during movement (Δ= 0.80, SD = 1.09), and (5) the ability to straighten the knee fully (Δ= 0.54, 1.44). There was greater improvement for the KOOS questions pertaining to meniscal versus mechanical symptoms (P < .00001). CONCLUSIONS KOOS symptoms as reported by subjects' responses to the questions pertaining to the frequency of knee pain, twisting/pivoting, running, squatting, and jumping showed the most improvement 1 year after isolated APM, whereas those relating to mechanical symptoms improved the least. Focusing on meniscal rather than mechanical symptoms may help surgeons better identify patients expected to benefit from APM. LEVEL OF EVIDENCE IV, retrospective analysis of prospectively collected data.
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Choi M, Lee SJ, Park CM, Ryoo S, Kim S, Jang JY, Kim HA. Arthroscopic Partial Meniscectomy versus Physical Therapy for Degenerative Meniscal Tear: a Systematic Review. J Korean Med Sci 2021; 36:e292. [PMID: 34811974 PMCID: PMC8608923 DOI: 10.3346/jkms.2021.36.e292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/27/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Meniscal tears are commonly observed in patients with knee osteoarthritis (OA), however, clinical significance of such lesions detected by magnetic resonance imaging is in many cases unclear. This study aimed to determine the clinical effectiveness of arthroscopic partial meniscectomy (APM) compared with non-operative care in patients with knee OA. METHOD We used existing systematic reviews with updates of latest studies. Three randomized controlled studies were selected, where two studies compared the effects of APM plus physical therapy (PT) with PT alone and one compared APM alone and PT alone. While 1 study exclusively included OA patients, 2 studies included 21.1 and 12% of patients with no radiographic OA. Patients with knee locking were unanimously excluded. RESULTS Upon comparison of APM plus PT and PT alone, there was no significant difference observed in knee function, physical activity, or adverse events. Knee pain was observed to be significantly lower in the APM plus PT group at 6 months, but there was no difference between the two groups at 12 and 24 months. With respect to the comparison between APM alone and PT alone, PT was non-inferior based on the criteria for knee function during 24 months; however, knee pain was significantly reduced in the APM alone group. CONCLUSIONS Our study showed that knee pain was significantly improved in the APM group compared to non-operative care group at 6 months and over 24 months. Our result was based on only 3 randomized controlled trials (RCTs) revealing a significant knowledge gap, hence demanding more high-quality RCTs in OA patients. TRIAL REGISTRATION PROSPERO Identifier: CRD42020215965.
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Affiliation(s)
- Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Su Jung Lee
- College of Nursing, Korea University, Seoul, Korea
| | - Chan Mi Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seungeun Ryoo
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sunghyun Kim
- Korea Social Security Information Service, Seoul, Korea
| | - Ju Yeon Jang
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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Langhans MT, Strickland SM, Gomoll AH. Management of Chondral Defects Associated with Patella Instability. Clin Sports Med 2021; 41:137-155. [PMID: 34782070 DOI: 10.1016/j.csm.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cartilage defects of the patellofemoral joint are commonly found in association with patellar instability owing to abnormal biomechanics. Strategies to address chondral defects of the patellofemoral joint secondary to instability should first address causes of recurrent instability. Most patellofemoral chondral defects associated with instability are less than 2 cm2 and do not generally require intervention beyond chondroplasty. Larger defects of the patella and/or the trochlea can be repaired with osteochondral or surface cartilage repair.
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Affiliation(s)
- Mark T Langhans
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | | | - Andreas H Gomoll
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA.
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12
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Reito A, Harris IA, Karjalainen T. Arthroscopic partial meniscectomy: did it ever work? Acta Orthop 2021; 93:1-10. [PMID: 34605736 PMCID: PMC8815409 DOI: 10.1080/17453674.2021.1979793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023] Open
Abstract
Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT? A truly effective treatment needs a valid disease model that would biologically and plausibly explain the perceived treatment benefits. In the case of DMT, effectiveness requires a credible framework for the pain-generating process, which should be influenced by APM. Basic research, pathoanatomy, and clinical evidence gives no support to these frameworks. Moreover, treatment of DMT with an APM does not align with the traditional practice of medicine since DMT is not a reliable diagnosis for knee pain and no evidence-based indication exists that would influence patient prognosis from APM. A plausible and robust explanation supported by both basic research and clinical evidence is that DMTs are part of an osteoarthritic disease process and do not contribute to the symptoms independently or in isolation and that symptoms are not treatable with APM. This is further supported by the fact that APM as an intervention is paradoxical because the extent of procedure and severity of disease are both inversely associated with outcome. We argue that arthroscopic treatment of DMT is largely based on a logical fallacy: post hoc ergo propter hoc.
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Affiliation(s)
- Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Australia
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Bugbee W. What Role for Chondroplasty in the Knee?: Commentary on an article by Leslie J. Bisson, MD, et al.: "Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy. Analysis of Patient Outcomes and Degenerative Joint Disease at 5 Years in the Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial". J Bone Joint Surg Am 2021; 103:e70. [PMID: 34468417 DOI: 10.2106/jbjs.21.00652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- William Bugbee
- Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
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