Proponents of Arthroscopic partial meniscectomy (APM) point to improved knee pain and function and quality of life after surgery as evidence of its efficacy. However, 13 trials, rigorously summarised in 2017 in a clinical practice guideline based on two systematic reviews, provided strong evidence that APM offers, at best, only little short- to medium-term benefit for most patients with degenerative knee disease compared with sham surgery or nonsurgical management.
APM is associated with an increased risk of progression of knee OA and subsequent need for “corrective” surgery (high tibial osteotomy or total knee replacement). A recent study causes us to question APM more.
In this study, researchers followed patients for 5 years after a APM. They assessed whether surgery resulted in accelerated or delayed development of knee osteoarthritis. The study randomized 146 patients; 70 were assigned to APM and 76 to placebo surgery. At 5 years after surgery, 72% (48 of 67) in the APM group and 60% (44 of 74) in the placebo surgery group had at least one grade of progression in radiographic tibiofemoral knee OA. Both groups reported sustained improvement in knee symptoms and function but there were no relevant between-group differences.
In the end, APM was associated with a slightly increased risk of progression of radiographic knee osteoarthritis without any additional benefit on knee pain, other symptoms, or function compared with placebo surgery. We need to move past these pathoanatomic explanations for the pain. Pain is complex. Treat the patient, not the image.