PT  - JOURNAL ARTICLE
AU  - Raine Sihvonen
AU  - Mika Paavola
AU  - Antti Malmivaara
AU  - Ari Itälä
AU  - Antti Joukainen
AU  - Heikki Nurmi
AU  - Juha Kalske
AU  - Anna Ikonen
AU  - Timo Järvelä
AU  - Tero AH Järvinen
AU  - Kari Kanto
AU  - Janne Karhunen
AU  - Jani Knifsund
AU  - Heikki Kröger
AU  - Tommi Kääriäinen
AU  - Janne Lehtinen
AU  - Jukka Nyrhinen
AU  - Juha Paloneva
AU  - Outi Päiväniemi
AU  - Marko Raivio
AU  - Janne Sahlman
AU  - Roope Sarvilinna
AU  - Sikri Tukiainen
AU  - Ville-Valtteri Välimäki
AU  - Ville Äärimaa
AU  - Pirjo Toivonen
AU  - Teppo LN Järvinen
TI  - Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial
AID  - 10.1136/annrheumdis-2017-211172
DP  - 2017 May 18
TA  - Annals of the Rheumatic Diseases
PG  - annrheumdis-2017-211172
4099  - http://ard.bmj.com/content/early/2017/05/18/annrheumdis-2017-211172.short
4100  - http://ard.bmj.com/content/early/2017/05/18/annrheumdis-2017-211172.full
AB  - Objective To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus.Methods In this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35–65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out.Results In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, −4.3; 95% CI, −11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (−3.2; −8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (−0.4; −1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups.Conclusions In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.