More evidence against arthroscopy in OA

A two-year follow-up of the Finnish Degenerative Meniscal Lesion Study (FIDELITY) has confirmed that arthroscopic partial meniscectomy offers no additional benefit over sham surgery.

The randomised controlled study of 141 patients with knee symptoms consistent with degenerative medial meniscus tear, and no clinical or radiographic evidence of knee osteoarthritis, found both treated and control groups showed a marked improvement in all primary outcomes.

However there was no significant between-group differences in either primary or secondary outcomes.

Primary outcomes included the Western Ontario Meniscal Evaluation Tool (WOMET), the Lysholm knee score, and pain after exercise.  Secondary outcomes included patient satisfaction, return to normal activity, serious adverse events and meniscal symptoms.

Patients, caregivers and outcome assessor were all blinded to treatment allocation.

Professor Ian Harris, professor of orthopaedic surgery at the University of New South Wales, said the study reinforced earlier findings – reported here in the limbic –  of no significant between-group differences at 12-months follow-up.

“This study gives us a longer term view of the outcome comparing placebo surgery to meniscectomy for degenerative meniscus tears… the lack of difference between the two groups persists up to 24 months.”

The study found no evidence that sub-sets of patients with mechanical symptoms or certain meniscus tear characteristics were more likely to benefit from arthroscopic partial meniscectomy than others.

Professor Harris said there was now good evidence that the procedure was decreasing in popularity, at least in Australia.

“There has been a steady fall in the rate of surgery in patients aged 50 and over since a peak in 2011. Interestingly, rates are not falling in all countries, with inconsistency seen in reports so far,” he said.

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