ICYMI: How Different are RCT Patients From Those in the “Real World” and Why It Matters

Patients in randomized trials were generally similar to those in observational studies; this finding has real-world implications

What’s the Claim?

This is a neat study with a small but handy finding. We covered it in our Joint Replacement newsletter last month, and wanted to make sure that our Arthroscopy/Sports readers saw it. It’s on a theme that knee surgeons often argue about — whether to perform arthroscopic meniscal surgery in patients who are middle-aged or older and/or those with a little bit of arthritis in the knee (no one here’s doing it if there’s a lot of arthritis in there, I trust).

The authors compared patients in major randomized trials with those in observational studies to see whether or how those patients differed. This is important, because many surgeons worry that patients who participate in RCTs are different from patients in “real-world practice” on this topic, and because of that worry, they sometimes dismiss the results of RCTs (which have consistently found that arthroscopic meniscal surgery in middle adulthood or later, in knees even with minimal or no DJD, is ineffective). It would be nice to know whether that worry is reasonable or not.

This study, which is freely available in full-text form, looked hard but found few differences between the populations in the observational studies and the randomized trials. The former were slightly younger (by about three years), and the RCT patients had somewhat more severe symptoms. These differences seemed unlikely to have much impact on the outcomes we care about. The authors explored many other parameters and found no serious differences in those. In short, the patients in the RCTs seemed quite representative of “real-world practice.”

How’s It Stack Up?