Arthroscopic partial meniscectomy

The most common orthopedic procedure performed in the US.

Purpose of the procedure is to relieve symptoms attributed to a meniscal tear by removing torn meniscal fragments and trimming the meniscus to a stable rim.

Most patients with meniscal tears have associated degenerative knee disease, ranging from mild chondral changes not visible on x-rays to established osteoarthritis.

The number of arthroscopic surgical procedures to treat established knee osteoarthritis, with or without concomitant meniscal lesion, has decreased dramatically in recent years because of a lack of efficacy of arthroscopic surgery demonstrated in controlled trials.

The number of partial meniscectomies have increased by 50% recently.

Approximately 700,000 partial arthroscopic meniscectomies are performed annually in the US.

Partial arthroscopic meniscectomy combined with physical therapy in a randomized trial provide no better relief of symptoms than physical therapy alone in patients with the meniscal tear and knee osteoarthritis (Katz JN et al ).

In a randomized, double-blind, sham controlled trial in 146 patients 35-65 years of age who had knee symptoms consistent with degenerative medial meniscal tear and no knee osteoarthritis: randomized to arthroscopic partial meniscectomy or sham surgery-outcomes after arthroscopic partial meniscectomy were no better than those after six sham surgical procedure (Finish Degenerative Meniscal Lesion Study Group).

Arthroscopic surgery for degenerative meniscal tears in patients with mild knee osteoarthritis has no benefit for function or pain as analyzed by a meta-analysis.

Among patients with nonobstructive meniscal tears physical therapy is noninferior to arthroscopic partial meniscectomy for improving patient knee function over 24 month follow-up (ESCAPE).

Many patients with knee osteoarthritis (OA) also have degenerative meniscal tears, and while previous randomized trials found no benefit for arthroscopic surgery with severe arthritis, the role of the surgery in the context of milder OA is less clear.

A systematic review of the literature, identifying seven randomized trials with all patients having documented degenerative meniscal tears: found no improvement with surgery.

Patients with displaced, obstructive type meniscal tears have a different clinical situation than those with degenerative meniscal tears and APM is effective in these patients.

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