A study carried out at the University of Helsinki has found that repairing meniscal cartilage in the knee is often no more effective than a placebo, and around 10,000 surgeries performed annually in Finland may be unnecessary.
The ‘Finnish Degenerative Meniscal Lesion Study’ (FIDELITY) compared surgical treatment of degenerative meniscal tears with placebo surgery.
The FIDELITY trial was designed to determine whether keyhole surgery performed to partially remove the meniscus (arthroscopic meniscal resection) is an effective form of treatment when the tear is caused by degeneration.
The study involved 146 participants, aged between 35 and 65. Participants were randomly assigned to undergo either an arthroscopic partial meniscectomy or placebo surgery where the procedure was simulated.
A year after surgery, patients were asked about the healing of the knee, symptoms they had experienced, as well as their satisfaction with treatment and its results.
Patients were also asked what group they believed they had been in and whether they would be willing to choose the treatment they had received if they had to make the same decision again.
Twelve months after the procedure, from the patients who underwent the partial meniscectomy, it was found that 93% would choose the same treatment, while 96% of those in the placebo group would choose the same.
In addition, in both groups most patients were satisfied with the status of their knee and believed it felt better than before the procedure.
Helsinki University Central Hospital professor Teppo Jarvinen and Tampere Hatanpaa Hospital doctor Raine Sihvonen said these results demonstrate that surgery is not always an effective form of treatment.
"It’s difficult to imagine that such a clear result would result in no changes to treatment practices," the pair said in the study.
Surgical treatment involves the partial removal of the meniscus through keyhole surgery via arthroscopy; a minimally invasive surgical procedure using an arthroscope, a type of endoscope inserted into the joint via a small incision.
Sihvonen said by ceasing the procedures, which have proven ineffective, they would avoid performing 10,000 unncessary surgeries every year in Finland alone.
"The corresponding figure for the United States is at least 500,000 surgeries," Sihvonen added.
The Helsinki University Central Hospital, the Kuopio and Turku University Hospitals, the Hatanpää Hospital in Tampere, the Central Finland Central Hospital and the National Institute for Health and Welfare were part of the FIDELITY research project.
The study was published in the New England Journal of Medicine on 25 December 2013.
Image: Dr Raine Sihvonen performing arthroscopic knee surgery at the Hatanpää Hospital, Tampere. Photo: courtesy of Anri Sormunen.