Arthroscopic Knee Surgery and Sham Procedure Show Same Results

Patients who underwent a placebo surgery experienced the same outcomes and incidence of symptoms as patients who actually underwent arthroscopic partial meniscectomy, according to a new study.

Researchers at the University of Helsinki (Finland) conducted a multicenter, randomized, sham-controlled trial in 146 patients (35–65 years of age) participating in the Finnish Degenerative Meniscal Lesion (FIDELITY) study who had symptoms consistent with a degenerative medial meniscus tear, and no knee osteoarthritis (OA). Patients were randomly assigned to arthroscopic partial meniscectomy or to sham surgery. The primary outcomes were changes in the Lysholm score and the Western Ontario Meniscal Evaluation Tool (WOMET) score and in knee pain after exercise at 12 months after the procedure.


The results showed that there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean improvements in the Lysholm score for the partial-meniscectomy group was 21.7, compared with 23.3 points in the sham-surgery group; for the WOMET score, 24.6 and 27.1 points, respectively; and the score for knee pain after exercise was 3.1 and 3.3 points. There were no significant differences between groups in the number of patients who required subsequent knee surgery or serious adverse events. The study was published on December 26, 2013, in the New England Journal of Medicine (NEJM).

“By ceasing the procedures which have proven ineffective, we would avoid performing 10,000 useless surgeries every year in Finland alone,” said lead author Raine Sihvonen, MD. “The corresponding figure for the US is at least 500,000 surgeries.”

“Based on these results, we should question the current line of treatment according to which patients with knee pain attributed to a degenerative meniscus tear are treated with partial removal of the meniscus, as it seems clear that instead of surgery, the treatment of such patients should hinge on exercise and rehabilitation,” added senior author Teppo Järvinen, MD, PhD.

Arthroscopic meniscectomy is an outpatient minimally invasive surgical (MIS) procedure used to treat a torn meniscus cartilage in the knee, often resulting from a sport-related injury. Traumatic tears usually occur as a result of a twisting or hyperflexion injury, while degenerative tears are more common in people over 40 and may occur without a specific injury. Since only the outer 1/4 of the meniscus is vascularized, repairs are successful when the tear occurs in this region of the meniscus. Tears in the nonvascular region are unlikely to heal and therefore are removed.

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