Arthroscopic Partial Meniscectomy for Degenerative Tears: Deimplementation and Why Referrals Persist
DOI:
https://doi.org/10.5281/zenodo.22548637Keywords:
Meniscectomy, Degenerative meniscus tear, Arthroscopy, Deimplementation, Knee osteoarthritis, Sham surgery trialAbstract
A series of randomised controlled trials, including sham-surgery-controlled designs, has found
arthroscopic partial meniscectomy for degenerative meniscus tears in middle-aged and older patients
produces no meaningful benefit over structured exercise therapy, and in some trials no benefit over sham
surgery, findings now reflected in multiple international clinical practice guidelines recommending
against the procedure for this indication. Reported procedure volumes have fallen substantially since this
evidence emerged, but referral and surgery for degenerative tears persist at levels the trial evidence does
not support. This review synthesises the trial, guideline, and deimplementation-science literature to
characterise both the strength of the evidence against routine meniscectomy for this indication and the
reported reasons referral pathways have proven resistant to full deimplementation.
References
Sihvonen R, Paavola M, Malmivaara A, et al. "Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear". N Engl J Med 369(2013):2515-2524.
Katz JN, Brophy RH, Chaisson CE, et al. "Surgery versus physical therapy for a meniscal tear and osteoarthritis". N Engl J Med 368(2013):1675-1684.
Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM. "Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up". BMJ 354(2016):i3740.
Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S. "Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial". Knee Surg Sports Traumatol Arthrosc 15(2007):393-401.
Herrlin SV, Wange PO, Lapidus G, Hallander M, Werner S, Weidenhielm L. "Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up". Knee Surg Sports Traumatol Arthrosc 21(2013):358-364.
Yim JH, Seon JK, Song EK, et al. "A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus". Am J Sports Med 41(2013):1565-1570.
Thorlund JB, Juhl CB, Roos EM, Lohmander LS. "Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms". BMJ 350(2015):h2747.
van de Graaf VA, Noorduyn JCA, Willigenburg NW, et al. "Effect of early surgery vs physical therapy on knee function among patients with nonobstructive meniscal tears: the ESCAPE randomized clinical trial". JAMA 320(2018):1328-1337.
Noorduyn JCA, van de Graaf VA, Willigenburg NW, et al. "Effect of physical therapy vs arthroscopic partial meniscectomy in people with degenerative meniscal tears: five-year follow-up of the ESCAPE randomized clinical trial". JAMA Netw Open 5(2022):e2220394.
Beaufils P, Becker R, Kopf S, et al. "Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus". Knee Surg Sports Traumatol Arthrosc 25(2017):335-346.
Englund M, Guermazi A, Lohmander LS. "The role of the meniscus in knee osteoarthritis: a cause or consequence?". Radiol Clin North Am 47(2009):703-712.
Abram SGF, Judge A, Beard DJ, Price AJ. "Adverse outcomes after arthroscopic partial meniscectomy: a study of 700,000 procedures in the national Hospital Episode Statistics database for England". Lancet 392(2018):2194-2202.
Siemieniuk RAC, Harris IA, Agoritsas T, et al. "Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline". BMJ 357(2017):j1982.
Brignardello-Petersen R, Guyatt GH, Buchbinder R, et al. "Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review". BMJ Open 7(2017):e016114.
Beaudreuil J, Bendaya S, Faucher M, et al. "Clinical practice guidelines for the management of meniscal lesions and associated osteoarthritis of the knee". Joint Bone Spine 80(2013):S0959.
Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M. "Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis". CMAJ 186(2014):1057-1064.
Moseley JB, O'Malley K, Petersen NJ, et al. "A controlled trial of arthroscopic surgery for osteoarthritis of the knee". N Engl J Med 347(2002):81-88.
Lamplot JD, Brophy RH. "The role for arthroscopic partial meniscectomy in knees with degenerative changes: a review of the literature". Bone Joint J 100-B(2018):719-727.
Skou ST, Roos EM. "Good Life with osteoArthritis in Denmark (GLA:D): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide". BMC Musculoskelet Disord 18(2017):72.
Skou ST, Thorlund JB, Rathleff MS, et al. "Early surgery or exercise and education for meniscal tears: a randomized clinical trial". Ann Intern Med 176(2023):1478-1489.
Rongen JJ, Rovers MM, van Tienen TG, Buma P, Hannink G. "Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: a multi-center longitudinal observational study using data from the osteoarthritis initiative". Osteoarthritis Cartilage 25(2017):23-29.
Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. "The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis". J Orthop Sports Phys Ther 47(2017):373-390.
Buchbinder R, Harris IA, Sprowson A. "Management of degenerative meniscal tears and the role of surgery". BMJ 350(2015):h2212.
Feeley BT, Liu S, Garner AM, Zhang AL, Pietzsch JB. "The cost-effectiveness of meniscal repair versus partial meniscectomy: a model-based projection for the United States". Knee 23(2016):674-680.
Bhattacharyya T, Gale D, Dewire P, et al. "The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee". J Bone Joint Surg Am 85(2003):4-9.
Zanetti M, Pfirrmann CW, Schmid MR, Romero J, Seifert B, Hodler J. "Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees". AJR Am J Roentgenol 181(2003):635-641.
Englund M, Guermazi A, Gale D, et al. "Incidental meniscal findings on knee MRI in middle-aged and elderly persons". N Engl J Med 359(2008):1108-1115.
Grol R, Grimshaw J. "From best evidence to best practice: effective implementation of change in patients' care". Lancet 362(2003):1225-1230.
Niven DJ, Mrklas KJ, Holodinsky JK, et al. "Towards understanding the de-adoption of low-value clinical practices: a scoping review". BMC Med 13(2015):255.
Prasad V, Ioannidis JP. "Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices". Implement Sci 9(2014):1.
