Arthroscopic partial meniscectomy: did it ever work?

A narrative review from basic research to proposed disease framework and science of clinical practice

Authors

  • Aleksi Reito Department of Orthopaedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Finland https://orcid.org/0000-0002-6903-6461
  • Ian A Harris Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Australia https://orcid.org/0000-0003-0887-7627
  • Teemu Karjalainen Central Finland Hospital, Jyväskylä, Finland

DOI:

https://doi.org/10.1080/17453674.2021.1979793

Keywords:

Arthroscopy, Knee, meniscectomy

Abstract

Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT? A truly effective treatment needs a valid disease model that would biologically and plausibly explain the perceived treatment benefits. In the case of DMT, effectiveness requires a credible framework for the pain-generating process, which should be influenced by APM. Basic research, pathoanatomy, and clinical evidence gives no support to these frameworks. Moreover, treatment of DMT with an APM does not align with the traditional practice of medicine since DMT is not a reliable diagnosis for knee pain and no evidence-based indication exists that would influence patient prognosis from APM. A plausible and robust explanation supported by both basic research and clinical evidence is that DMTs are part of an osteoarthritic disease process and do not contribute to the symptoms independently or in isolation and that symptoms are not treatable with APM. This is further supported by the fact that APM as an intervention is paradoxical because the extent of procedure and severity of disease are both inversely associated with outcome. We argue that arthroscopic treatment of DMT is largely based on a logical fallacy: post hoc ergo propter hoc.

Downloads

Download data is not yet available.

Published

2022-01-03

How to Cite

Reito, A., Harris, I. A., & Karjalainen, T. (2022). Arthroscopic partial meniscectomy: did it ever work? : A narrative review from basic research to proposed disease framework and science of clinical practice. Acta Orthopaedica, 93, 82–91. https://doi.org/10.1080/17453674.2021.1979793

Issue

Section

Perspective