• Knee Osteoarthritis
• Epidemiology
• Physcial Therapy
• Orthopedic Surgery

Increased use of MRI in the quest to explain symptoms, and patients’ hope for a ‘quick-fix’, often challenge healthcare professionals in their choice of treatment for the painful ageing knee. In the USA, there are about one million knee arthroscopies per year and the majority involve removal of torn meniscal tissue in middle-aged patients. The absolute number of arthroscopic partial meniscectomies (APMs) in Europe is unknown but may be even greater due to the larger European population. The popularity of this procedure is understandable — multiple case series and randomised controlled trials (RCTs), not to mention doctors’ personal observations of patients, show sustained improvement after APM. However, the last few years, the efficacy of the actual therapeutic element, resection of meniscal tissue, has been called into question.

A hallmark RCT is the exquisitely designed, randomised, double-blinded, sham-surgery-controlled Finnish Degenerative Meniscal Lesion Study (FIDELITY).1 The main findings of the trial so far are summarised in these short film clips:

• FIDELITY New Engl J Med 2013

• FIDELITY Ann Intern Med 2016

In the provocative New Engl J Med article from 2013, Sihvonen et al reported that outcomes in the middle-aged patients, where resection of meniscus was only simulated during the diagnostic arthroscopy, were very similar to those of actual APM. Patients in both the APM arm and the sham-surgery arm improved substantially and sustainably, indicating that the improvement observed after APM is attributable to what are collectively referred to as contextual effects. Thus, it was not the actual therapeutic element of the surgery, which is resection of torn meniscal tissue. Now, in the present 2-year follow-up of the FIDELITY patients,2 Sihvonen et al strengthen their original …