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Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial.

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.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Sihvonen R,Englund M,Turkiewicz A,Järvinen TL,Finnish Degenerative Meniscal Lesion Study Group.

doi

10.7326/M15-0899

subject

Has Abstract

pub_date

2016-04-05 00:00:00

pages

449-55

issue

eissn

0003-4819

issn

1539-3704

pii

2490532

journal_volume

164

pub_type

杂志文章,多中心研究,随机对照试验

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Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial.