This post was written with Consensus AI Academic Search Engine – please read our Disclaimer at the end of this article. Meniscus tears are a common knee injury, particularly among middle-aged and older adults. The meniscus is a C-shaped piece of cartilage that acts as a cushion between the femur and tibia. When it tears, it can cause pain, swelling, and limited knee function. Various surgical and non-surgical treatments are available, but the effectiveness of these treatments, particularly arthroscopic partial meniscectomy (APM), has been a subject of debate. This article reviews the current evidence on the efficacy and safety of APM compared to other treatment modalities for meniscus tears.
Arthroscopic Partial Meniscectomy vs. Placebo Surgery
Several studies have investigated the effectiveness of APM compared to placebo surgery. A randomized controlled trial with a 2-year follow-up found no significant difference in outcomes between APM and placebo surgery in patients with degenerative medial meniscus tears. The study measured outcomes using the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores, as well as knee pain after exercise, and found no significant between-group differences1. Another study with a 12-month follow-up also reported no significant differences in primary outcomes between APM and sham surgery, including Lysholm and WOMET scores and knee pain after exercise2.
Long-term Outcomes and Risks
The long-term effects of APM have also been studied. A 5-year follow-up of the Finnish Degenerative Meniscus Lesion Study (FIDELITY) trial found that APM was associated with a slightly increased risk of developing radiographic knee osteoarthritis compared to placebo surgery. There were no significant differences in patient-reported outcomes such as WOMET and Lysholm knee scores, or knee pain after exercise5. These findings suggest that APM may not provide long-term benefits and could potentially increase the risk of knee osteoarthritis.
Mechanical Symptoms and APM
Mechanical symptoms such as knee catching or locking are often cited as indications for APM. However, a secondary analysis of a randomized trial found that APM did not provide additional benefits over sham surgery in relieving these symptoms. The study concluded that mechanical symptoms might not be caused by a degenerative meniscus tear, and caution should be exercised in using these symptoms as an indication for APM3.
Alternative Surgical Techniques
Other surgical techniques have been explored to improve meniscus healing and function. A study comparing meniscal repair with and without biological augmentation using a bone marrow venting procedure (BMVP) found that BMVP significantly improved the rate of meniscus healing and functional outcomes4. Another study investigated the use of platelet-rich plasma (PRP) in meniscal repair and found that PRP augmentation resulted in better meniscus healing and functional outcomes compared to a control group7.
Non-Surgical Treatments
Non-surgical treatments, including physical therapy and strengthening exercises, have also been compared to APM. A randomized controlled trial found no significant differences in pain relief, knee function, or patient satisfaction between APM and nonoperative treatment for degenerative horizontal tears of the medial meniscus10. These findings suggest that non-surgical treatments can be as effective as APM for certain types of meniscus tears.
Conclusion
The current evidence suggests that APM may not provide significant benefits over placebo surgery or non-surgical treatments for degenerative meniscus tears. Long-term risks, such as the development of knee osteoarthritis, should also be considered. Alternative surgical techniques, such as BMVP and PRP augmentation, show promise in improving meniscus healing and function. Clinicians should carefully evaluate the indications for APM and consider non-surgical treatments as viable options for managing meniscus tears.
Disclaimer
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