Recent research from Finland is challenging the widespread use of partial arthroscopic meniscectomy (APM), a surgical procedure to trim or remove damaged meniscus cartilage in the knee. The study, published in the New England Journal of Medicine, suggests that for many middle-aged patients, this surgery may offer no significant benefit and could even be harmful, leading to a higher incidence of knee osteoarthritis and subsequent knee replacements.
Tom Hooper, a 43-year-old runner, experienced a year of pain and his knee locking due to a bucket handle meniscus tear. He underwent APM surgery, but nine months later, he was still in pain and required steroid injections and physiotherapy. While his pain has since subsided, his knee remains inflexible. Hooper's experience highlights a growing debate about the necessity and efficacy of such procedures, particularly as patients undergoing them are getting younger.
Meniscus tears are common injuries, affecting individuals from young athletes to older adults experiencing age-related degeneration. Symptoms can include pain, swelling, stiffness, and a sensation of the knee locking or giving way. While rest and physiotherapy are often initial treatments, surgery is sometimes recommended for more severe cases. Approximately 75,000 such operations are performed annually in the UK's National Health Service alone, with thousands more in the private sector.
The Finnish study, which involved 146 patients aged 35 to 65, found that after ten years, those who received APM surgery were no better off in terms of quality of life, knee function, or pain compared to those who underwent sham surgery. Furthermore, the surgery group exhibited higher rates of knee osteoarthritis and more invasive procedures like total knee replacements or high tibial osteotomies.
Professor Teppo Jarvinen, the study's principal investigator, stated that APMs exemplify how common therapies can be ineffective or harmful. He noted that while some organizations have recommended discontinuing the procedure, others, including the American Academy of Orthopaedic Surgeons and the British Association for Surgery of the Knee (BASK), continue to endorse it.
This is not the first study to raise questions about meniscus surgery. A 2023 review of over 600 patients found no benefit from APM compared to non-surgical or sham treatments. Experts like Professor Philip Conaghan suggest that many knee arthroscopies, including meniscus trimming, are overperformed, and that asymptomatic tears are common in individuals over 40, implying that the tear itself may not always be the source of pain.
BASK guidelines recommend APM primarily for cases where the joint is mechanically locking, a distinct issue from temporary stiffness after inactivity. However, there is concern that the new research might deter patients who genuinely require surgery, particularly younger individuals with sports-related injuries, who were not included in the Finnish study. BASK president Alasdair Santini warned that scaring off younger patients could lead to further damage. Chinmay Gupte, president-elect of BASK, added that underdiagnosis and undermangement of knee problems in younger people is a significant issue, and APM might still benefit middle-aged patients with specific types of painful, internally catching meniscus tears.