Meniscus tears are a common injury, particularly in the older population, and often occur as a result of degenerative changes in the knee joint. A partial meniscectomy, a surgical procedure in which the damaged part of the meniscus is removed, has long been the standard treatment for such tears.
Partial meniscectomy is a very technical term, more commonly known as an arthroscopy or ‘scope’. Knee arthroscopy is a minimally invasive surgical procedure used to diagnose and treat problems in the knee joint. It involves making small incisions in the knee and inserting a tiny camera, called an arthroscope, to allow the surgeon to see inside the knee joint. The arthroscope is connected to a video monitor, which displays images of the knee joint to the surgeon.
During the procedure, the surgeon can use small instruments inserted through additional incisions in the knee to repair or remove damaged tissue, such as torn meniscus or damaged cartilage. Knee arthroscopy can also be used to remove loose fragments of bone or cartilage, repair ligament injuries, and diagnose joint problems.
Knee arthroscopy is typically performed under general anaesthesia or regional anaesthesia, which numbs the knee and surrounding area. The procedure usually takes about 30 minutes to an hour, depending on the extent of the problem.
Despite the popularity of these surgeries over the preceding decades, recent studies have challenged the efficacy of this procedure, particularly for non-traumatic degenerative meniscal tears.
The meniscus is a C-shaped piece of cartilage that acts as a cushion between the femur and tibia in the knee joint. Meniscal tears can occur from direct trauma or because of degenerative changes in the knee joint. The symptoms of a meniscal tear can include pain, swelling, stiffness, and difficulty moving the knee. The severity of symptoms can vary depending on the extent of the tear and the individual’s activity level.
Partial meniscectomy has been the traditional treatment for meniscal tears. The procedure involves the removal of the damaged portion of the meniscus. This can relieve pain and improve knee function, particularly in the short term. However, the long-term benefits of the procedure are now being called into question, particularly for non-traumatic degenerative meniscal tears.
Recent studies have found that partial meniscectomy may not be more effective than non-surgical treatments, such as physical therapy, for degenerative meniscal tears. In fact, some studies have found that patients who undergo partial meniscectomy may experience no significant improvement in pain or function compared to those who receive non-surgical treatments. Additionally, partial meniscectomy carries a risk of complications, such as infection and blood clots.
One study published in the New England Journal of Medicine compared partial meniscectomy with a sham surgery in patients with non-traumatic degenerative meniscal tears. A sham meniscectomy surgery is a type of placebo surgery in which patients are led to believe that they have undergone a real meniscectomy surgery, but in fact, no actual surgical intervention is performed. Instead, the surgical procedure is simulated to create the impression of a real surgery. The study found that both groups had similar outcomes, with no significant difference in pain or function between the two groups. This suggests that partial meniscectomy is no better than sham surgery.
Another study published in the British Medical Journal found that physical therapy was just as effective as partial meniscectomy for improving pain and function in patients with degenerative meniscal tears. The study also found that physical therapy was less expensive than surgery and had fewer complications.
A recent study published this year in Knee Surgery, Sports Traumatology and Arthroscopy, concluded there was no evidence in support of partial meniscectomy in adults with degenerative and non-obstructive meniscal symptoms. This was a level 1 evidence-based review, also known in the scientific community as the highest level of quality evidence. This study also concluded that identical outcomes could be gained from structured physiotherapy and therefore the surgery gave no added benefit.
While partial meniscectomy may still be a viable treatment option for some patients with acute traumatic tears, which the surgeon may be able to repair by suturing rather than meniscectomy, the lack of evidence to support its use for non-traumatic degenerative tears suggests that a more conservative approach, such as physical therapy, may be a better option for many patients.
