Meniscus Surgery May Not Provide Additional Relief

Fake surgery for meniscal tear improved symptoms as much as real procedure

(RxWiki News) When knee cartilage is damaged, patients often choose surgery to reduce pain and treat the symptoms. New research shows that the surgery may not be very effective.

Patients with degenerative meniscus tears participated in a trial testing a common meniscal tear surgery against a fake surgery.

One year after the procedures, patients in both groups reported similar improvements in pain and quality of life.

The researchers concluded that the actual procedure did not provide any additional benefits over the sham surgery.

"Talk to your doctor about the best treatment for a meniscal tear."

Teppo Jarvinen, MD, PhD, of the Department of Orthopedics and Traumatology in Helsinki University Central Hospital, led this study.

According to Dr. Jarvinen and colleagues, arthroscopic partial meniscectomy is the most common orthopedic procedure in America.

It is used to treat a torn meniscus, the cartilage in the knee, which often causes pain, swelling and tenderness.

During an arthroscopic partial meniscectomy, a surgeon removes some parts of the torn meniscus and trims the cartilage back.

This trial tested the actual procedure against a placebo surgery, during which the patients thought they were undergoing an operation but were not.

The researchers recruited 146 participants over five years who had a degenerative meniscus tear. Degenerative tears to the meniscus usually occur in middle-aged to older adults due to wear and tear that weakens the cartilage.

These patients were between 35 to 65 years old and had not responded to previous treatments.

A total of 70 patients were assigned to the arthroscopic partial meniscectomy and underwent the procedure, and 76 were assigned to a "sham surgery," during which a surgery was simulated to make the patient believe they underwent the operation.

All patients received postoperative care and were assessed at a follow-up visit 12 months later.

The follow-up consisted of a questionnaire on adverse events, knee symptoms and the patient's satisfaction with the operation.

Additionally, doctors assessed the pain after exercise and level of symptoms.

These researchers found that both groups experienced significant improvements in knee pain, symptoms and quality of life. They noted no significant differences between the groups in terms of treatment success.

Two patients in the operation group and five patients in the sham surgery group reported persistent, severe symptoms.

During the follow-up, 47 percent of the sham surgery patients and 38 percent of the operation patients guessed that they had undergone a sham procedure.

The researchers concluded that the actual procedure did not provide significant benefits over the sham surgery.

This study was published in the New England Journal of Medicine on December 26.

The research was supported by grants from the Sigrid Juselius Foundation, the Competitive Research Fund of Pirkanmaa Hospital District and the Academy of Finland. Some of the authors disclosed financial ties to pharmaceutical companies.

Review Date: 
December 30, 2013