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Should You Have Arthroscopic Surgery for a Medical Meniscus Tear?

Arthroscopy of the knee is one of the most frequently performed medical procedures. The number of knee arthroscopies performed in the United States rose by 49% from 1996 to 2006; by 2006, arthroscopic knee procedures made up 51% of all procedures performed in outpatient medical centers. For many conditions, such as torn ligaments, arthroscopy has been shown to be effective, less invasive, and lead to shorter recovery times than more invasive procedures.

But when it comes to treating one of the most common knee injuries -- degenerative tears of the medial meniscus* -- arthroscopy might not be the best choice, according to results of a trial recently published in the New England Journal of Medicine. The trial involved a group of 141 people ages 35 to 65 years who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. The researchers randomly divided study participants into two groups. One group had an arthroscopy procedure in which the torn part of the meniscus was trimmed back, called a partial meniscotomy. Participants in the other group received a sham surgery.

The results? Researchers concluded that "the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure." In other words, there was no difference whatsoever, whether the participants had the real or fake surgery.

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*The meniscus is a crescent-shaped ligament that pads the space between the bottom of the thigh bone (femur) and the top of the shin bone (tibia). The medial meniscus is located on the inside, toward the midline of the body.

Sources

Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am. 2011 Jun 1;93(11):994-1000. doi:10.2106/JBJS.I.01618.

Sihvonn R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL; Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013 Dec 26;369(26):2515-24. doi: 10.1056/NEJMoa1305189.