Sham surgery shows similar results to arthroscopic partial meniscectomy

Issue: September 2014

HOLLYWOOD, Fla., USA — Patients with degenerative meniscus tears found about as much relief from sham surgery as they did from a legitimate arthroscopic partial meniscectomy procedure, based on results of a multicenter, double-blind trial.

“In the sham surgery group, there was absolutely no difference between the groups in any of the three primary outcomes at any of the three follow-up time points (2 months, 6 months and 12 months). The Lysholm Knee Score, no difference; the WOMET [Western Ontario Meniscal Evaluation Tool] score, no difference; and the pain after exercise, no difference between the groups,” Teppo Järvinen, MD, PhD, said at the Arthroscopy Association of North America Annual Meeting. “Seventy percent of patients in the sham surgery group said they were satisfied, 83% said they were improved, and 96% were willing to undergo the procedure if asked again.”

Järvinen and colleagues recruited 146 patients between the ages of 35 years and 65 years with persistent pain on the medial joint line and clinical findings consistent with a medial meniscal tear and these findings were corroborated both with MRI and, ultimately, arthroscopically.

Patients with an obvious trauma-induced onset of symptoms and a locked knee or clinical and/or radiographic evidence of knee osteoarthritis were excluded from the study. However, patients with an acute onset of symptoms due to something trivial, such as the twisting of their knee while running or standing up from a squatting position, were included.

Patients were randomized into two groups to either undergo arthroscopic partial meniscectomy (APM) or sham arthroscopic surgery to treat degenerative meniscus tears. The APM involved removal of damaged or loose parts of the meniscus and in the sham procedure those steps were simulated.

The primary outcome measures used were changes in the Lysholm and WOMET scores, which range from 0 to 100, with 100 being the “perfect knee,” and knee pain after exercise, rated on a scale of 0 to 10, was also noted 12 months after the procedures.

“For the APM results, knee scores for the patients saw statically significant improvement at 2 [months], 6 [months] and 12 months. Also, at 2 months they were around 3 at the knee pain after exercise score and the improvement continued through the 12-month follow-up,” Järvinen said. “Seventy-seven percent of patients were satisfied with the procedure, 90% considered that they were improved, and 93% were willing to repeat the task again.”

To his knowledge, these were the best results for APM ever published for the procedure.

The sham surgery group showed extraordinarily similar results, according to Järvinen. For example, there was no difference in the two groups’ Lysholm and WOMET scores, as well as in the knee pain after exercise score.

“Based on this, this is our conclusion: Arthroscopic partial meniscectomy provides no benefit over sham surgery in patients with symptomatic degenerative medial meniscus tear and no knee osteoarthritis,” Järvinen said. – by Robert Linnehan

Reference:
Järvinen T. Paper #SS-72. Presented at: Arthroscopy Association of North America Annual Meeting; May 1-3, 2014; Hollywood, Fla., USA.

For more information:
Teppo Järvinen, MD, PhD, can be reached at the Department of Orthopedics and Traumatology, Helsinki University Central Hospital/Töölö Hospital, Topeliuksenkatu 5, P.O. Box 266, 00029 HUS, Helsinki, Finland; email: teppo.jarvinen@helsinki.fi.

Disclosure: The study was supported by grants from the Sigrid Juselius Foundation, the Competitive Research Fund of Pirkanmaa Hospital District, and the Academy of Finland.