Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial

Autor: Sihvonen, Raine, Paavola, Mika, Malmivaara, Antti, Itälä, Ari, Joukainen, Antti, Nurmi, Heikki, Kalske, Juha, Ikonen, Anna, Järvelä, Timo, Järvinen, Tero A. H., Kanto, Kari, Karhunen, Janne, Knifsund, Jani, Kröger, Heikki, Kääriäinen, Tommi, Lehtinen, Janne, Nyrhinen, Jukka, Paloneva, Juha, Päiväniemi, Outi, Raivio, Marko, Sahlman, Janne, Sarvilinna, Roope, Tukiainen, Sikri, Välimäki, Ville-Valtteri, Äärimaa, Ville, Toivonen, Pirjo, Järvinen, Teppo L. N., FIDELITY Finnish Degenerative
Přispěvatelé: School of Medicine / Clinical Medicine, Department of Surgery, I kirurgian klinikka (Töölö), Clinicum, HUS Musculoskeletal and Plastic Surgery
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Osteoarthritis
Meniscus (anatomy)
GUIDELINES
Menisci
Tibial
Arthroscopy
0302 clinical medicine
Postoperative Complications
Immunology and Allergy
Medicine
030212 general & internal medicine
Finland
030222 orthopedics
Lysholm Knee Score
treatment
Middle Aged
MECHANICAL SYMPTOMS
Intention to Treat Analysis
Tibial Meniscus Injuries
medicine.anatomical_structure
Treatment Outcome
Patient Satisfaction
RELIABILITY
Female
medicine.symptom
Medial meniscus
Adult
medicine.medical_specialty
Immunology
UNITED-STATES
KNEE OSTEOARTHRITIS
Placebo
General Biochemistry
Genetics and Molecular Biology
CLASSIFICATION
03 medical and health sciences
Rheumatology
MANAGEMENT
Humans
METAANALYSIS
Aged
Meniscectomy
REPAIR
Intention-to-treat analysis
business.industry
MEDICINE
Recovery of Function
Clinical and Epidemiological Research
medicine.disease
3126 Surgery
anesthesiology
intensive care
radiology
Surgery
Knee pain
Orthopedic surgery
orthopaedic surgery
business
Follow-Up Studies
Zdroj: Annals of the Rheumatic Diseases
Popis: Objective To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus. Methods In this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35–65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out. Results In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, −4.3; 95% CI, −11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (−3.2; −8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (−0.4; −1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups. Conclusions In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.
published version
peerReviewed
Databáze: OpenAIRE
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