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Knee ops to repair torn cartilage are 'waste of time'

Jan 1st 2014 at 8:33 PM

New research from Finland suggests many thousands of people who have arthroscopic knee surgery to fix a torn cartilage could be wasting their time. A report on the Finnish Degenerative Meniscal Lesion Study (FIDELITY), published recently in the New England Journal of Medicine, finds that the benefits of keyhole operations to repair degenerative meniscal tears are no better than sham operations. Previous studies have shown that keyhole surgery on the knee does not help patients with osteoarthritis and such procedures have become less common for arthritis sufferers. In the meantime, keyhole surgery to repair torn cartilage has risen significantly, despite lack of evidence that it actually helps, says the Finnish team.

Knee problems other than arthritis that cause stiffness and pain are very common, and are most often caused by gradual wear and tear rather than sudden injury or trauma. The most common diagnosis that requires treatment is a torn meniscus, a crescent-shaped cartilage that acts like a shock absorber and helps stabilize the knee. The usual procedure for repairing a torn meniscus is keyhole surgery or arthroscopy, where the surgeon inserts a scope through a small incision to examine the joint and, if required, also partially removes the damaged cartilage through another incision.

Comparing partial removal of damaged cartilage with sham procedure In this new study, the Finnish team recruited 146 patients aged from 35 to 65 with meniscal tears that had developed through wear and tear rather than injury or trauma. None of the patients had arthritis of the knee. The researchers randomnly assigned the patients to one of two groups: one underwent keyhole surgery to partially remove the damaged meniscus and the other underwent a sham procedure. In the sham procedure, the surgeons simulated the real operation.

They manipulated the patient's knee and handled surgical instruments near the knee so the patient was under the impression they were being operated on. Thus both groups underwent arthroscopy, where the scope in inserted into the keyhole so the surgeon can look at the torn cartilage, but only one group actually had part of the cartilage removed. But neither the patients, the people caring for them after the operation, nor the researchers analyzing the results knew which patients had undergone the real procedure and which had just had the sham operation. Both groups of patients equally satisfied with the results

The results show that a year later, both groups of patients had an equally low rate of symptoms and were equally satisfied with the overall situation of their knee. Both groups of patients said they believed their knee felt better than before the operation. When asked if they would choose the same procedure again, 93% of the partial meniscectomy group said they would, as did 96% of the sham procedure group.

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