More Support for Avoiding Arthroscopic Meniscal Surgery in Middle Adulthood and Later

What’s the Claim?

This is a neat study with a small but handy finding, one that speaks to a topic 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 (I hope that no one is still arguing for doing it if there is a lot of arthritis in there).

These authors compared several key randomized trials with observational studies to see whether the participants differed between them. This is important, because some surgeons suspect that patients who participate in RCTs are different from patients in “real-world practice” on this topic, and they use that suspected difference to 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).

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 3 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?

I’m not aware of any other studies of this kind, though I hope that this study group will do likewise for other topics where this argument comes up (SLAP tears, spine fusions for back pain, we’re looking at you).

What’s Our Take?

The authors’ claim that patients in the RCTs “appear to be generally representative of the target population” holds water, and is important. Based on this discovery, it seems wrong to discount high-quality randomized trial data on the basis that those studies somehow don’t apply to the patients whom surgeons treat in regular practices. And those studies consistently have found that arthroscopic meniscal surgery in the patient population that arthroplasty surgeons treat — middle-aged adults (or older) with degenerative meniscal tears — is ineffective, particularly if any arthritis is present. Until or unless randomized trials find otherwise, this is an operation to consign to the heap of discredited treatments.

Source

Wijn SRW, Hannink G, Thorlund JB, et al. Arthroscopic Partial Meniscectomy for the Degenerative Meniscus Tear: A Comparison of Patients Included in RCTs and Prospective Cohort Studies. Acta Orthop. 2023;94:570-576.