Katz JN, Brophy RH, Chaisson CE, et al., Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med (2013) March 19, online first
Buchbinder R., Editorial: Meniscectomy in patients with knee osteoarthritis and a meniscal tear? N Engl J Med (2013) March 19 online first
The largest randomized controlled trial (RCT) so far has found no benefit to arthroscopic partial meniscectomy (APM) even in patients with symptomatic meniscal tears,says a report in the New England Journal of Medicine. An accompanying editorial said that APM should now be limited to the minority of cases that don’t improve after physical therapy. (But physical therapy is also unproven, the editorial said.)
In the METEOR trial, 351 symptomatic patients with meniscal tears and osteoarthritis (OA) on imaging were all offered standard physical therapy and randomly assigned to APM or control. There was no improvement in the primary outcome – change in the WOMAC score at six months. This trial, at seven institutions, confirms a smaller RCT with 90 patients at one institution which also found no benefit. Earlier RCTs found no benefit of APM in OA generally.
A high proportion (30%) of patients in the control group crossed over to APM. The investigators concluded that the groups of patients were similar and that this did not affect the conclusions. The editorial argued that sham surgery was ethically justified and necessary, to exclude a placebo effect and to exclude the potential bias of crossovers.
There was no measurable increase in adverse effects in the APM group, but the editorial said that this study was underpowered to assess adverse effects, even after long-term followup. Known risks include thrombosis, infection, and anesthesia-related complications, and APM may increase progression to OA and joint replacement.
Almost half a million APM procedures are performed annually in the U.S., and millions worldwide.