Raine Sihvonen, MD, PhD; Martin Englund, MD, PhD; Aleksandra Turkiewicz, MSc; Teppo L.N. Järvinen, MD, PhD; for the Finnish Degenerative Meniscal Lesion Study Group (*)
Acknowledgment: The authors thank Professor Jari Haukka and Heini Huhtala for help with the primary statistical plan and research coordinator Pirjo Toivonen for her vital role in the implementation of the study. They also thank Dr. Kari Tikkinen for his critical comments on the manuscript and Virginia Mattila for linguistic expertise and language revisions, as well as professors Rachelle Buchbinder and Ian Harris for their critical review of the final manuscript.
Grant Support: By the Jane and Aatos Erkko Foundation, Sigrid Jusélius Foundation, Competitive Research Fund of Pirkanmaa Hospital District, and Academy of Finland. Drs. Englund and Turkiewicz were supported by the Swedish Research Council, Region Skåne, Governmental Funding of Clinical Research within the National Health Service, the Swedish Rheumatism Association, and Lund University.
Disclosures: Dr. Sihvonen reports grants from the Competitive Research Fund of Pirkanmaa Hospital District during the conduct of the study, grants from the Maire Lisko Foundation and Duodecim/Finnish Medical Foundation outside the submitted work, and other from Merck Sharp & Dohme Finland and DePuy Synthes Finland outside the submitted work. Dr. Englund reports grants from the Swedish Research Council, Swedish Rheumatism Association, Governmental Funding of Clinical Research within the National Health Service, and Lund University during the conduct of the study. Dr. Järvinen reports grants from the Jane and Aatos Erkko Foundation, Sigrid Juselius Foundation, Competitive Research Fund of Pirkanmaa Hospital District, and Academy of Finland during the conduct of the study and personal fees from Amgen (speaker honorarium that was donated to the AllTrials campaign) outside the submitted work. Authors not named here have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?ms Num=M15-0899.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol and data set: Available from Dr. Järvinen (e-mail, firstname.lastname@example.org). Statistical code: Available from Ms. Turkiewicz (e-mail, email@example.com).
Requests for Single Reprints: Teppo L.N. Järvinen, MD, PhD, Department of Orthopaedics and Traumatology, University of Helsinki, Töölö Hospital, Topeliuksenkatu 5, 00014 University of Helsinki, Helsinki, Finland; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Sihvonen: Hatanpään Sairaala, Tampere, Hatanpäänkatu 24, 33900 Tampere, Finland.
Dr. Englund and Ms. Turkiewicz: Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Klinikgatan 22, SE-221 85 Lund, Sweden.
Dr. Järvinen: Department of Orthopaedics and Traumatology, University of Helsinki, Töölö Hospital, Topeliuksenkatu 5, 00014 University of Helsinki, Helsinki, Finland.
Author Contributions: Conception and design: R. Sihvonen, T.L.N. Järvinen.
Analysis and interpretation of the data: R. Sihvonen, M. Englund, A. Turkiewicz, T.L.N. Järvinen.
Drafting of the article: R. Sihvonen, M. Englund, A. Turkiewicz, T.L.N. Järvinen.
Critical revision of the article for important intellectual content: R. Sihvonen, M. Englund, A. Turkiewicz, T.L.N. Järvinen.
Final approval of the article: R. Sihvonen, M. Englund, A. Turkiewicz, T.L.N. Järvinen.
Provision of study materials or patients: T.L.N. Järvinen.
Statistical expertise: M. Englund, A. Turkiewicz.
Obtaining of funding: T.L.N. Järvinen.
Administrative, technical, or logistic support: T.L.N. Järvinen.
Collection and assembly of data: R. Sihvonen, T.L.N. Järvinen.
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.
To assess whether APM improves mechanical symptoms better than sham surgery.
Randomized, patient- and outcome assessor–blinded, sham surgery–controlled, multicenter trial. (ClinicalTrials.gov: NCT00549172)
5 orthopedic clinics in Finland.
Adults (aged 35 to 65 years) with a degenerative medial meniscus tear and no knee osteoarthritis.
APM or sham surgery.
Patients' self-report of mechanical symptoms before surgery and at 2, 6, and 12 months after surgery.
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).
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.
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.
Academy of Finland.
Raine Sihvonen, Martin Englund, Aleksandra Turkiewicz, Teppo L.N. Järvinen, . Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial. Ann Intern Med. 2016;164:449–455. doi: 10.7326/M15-0899
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Published: Ann Intern Med. 2016;164(7):449-455.
Published at www.annals.org on 9 February 2016
Hospital Medicine, Osteoarthritis, Rheumatology.
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