Concerns are mounting over the efficacy of arthroscopic partial meniscectomy (APM), a common surgical procedure to treat meniscus tears, particularly in middle-aged individuals. Recent research from Finland, published in the New England Journal of Medicine, suggests that this surgery may not provide significant benefits and could potentially cause more harm than good for certain patients.
The study, which involved 146 patients aged 35 to 65 with degenerative meniscus tears, found that those who underwent APM surgery to remove damaged or loose fragments of the meniscus experienced no better outcomes in terms of quality of life, knee function, or pain after exercise compared to those who received sham surgery. Furthermore, the surgery group showed a higher incidence of knee osteoarthritis and a greater need for total knee replacements or high tibial osteotomy procedures.
Professor Teppo Jarvinen, the study's principal investigator at Helsinki University, stated that the findings highlight how a widely used therapy can be ineffective or even harmful. He noted that while many clinical guidelines have recommended discontinuing APM for years, some professional organizations, such as 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 question meniscus surgery. A 2023 review by researchers from Denmark, Norway, and the Netherlands, published in Osteoarthritis and Cartilage, found no benefit for patients undergoing APM compared to non-surgical or sham treatments.
Philip Conaghan, a professor of musculoskeletal medicine at Leeds University, commented that arthroscopic knee procedures, including meniscus trimming, have been overperformed. He pointed out that asymptomatic meniscus tears are common in individuals over 40, suggesting that the tear itself may not always be the source of pain. Guidelines, including those from BASK, recommend APM primarily for cases where the joint is mechanically locked, a distinct condition from temporary stiffness after inactivity.
BASK acknowledges that many middle-aged individuals with meniscus problems may not require surgery. However, there is a concern that the new Finnish findings could deter patients, particularly younger individuals with sports-related injuries, who might genuinely benefit from surgery. Alasdair Santini, BASK president, warned that discouraging younger patients from undergoing necessary meniscus surgery could lead to further knee damage.
Chinmay Gupte, a consultant trauma and knee surgeon, added that underdiagnosis and undermangement of knee problems in younger people is a significant issue. He suggested that APM could still be beneficial for middle-aged individuals experiencing pain and locking due to a mobile meniscus flap that requires surgical intervention to facilitate a return to work.
Tom Hooper, a 43-year-old club runner who underwent APM for a bucket handle meniscus tear, shared his experience. Despite initial pain and stiffness post-surgery, he is optimistic about regaining full fitness with continued physiotherapy. He believes surgery was the right decision for his specific injury and advises others with similar sports-related tears not to be discouraged from seeking surgical options.