Partial Meniscectomy Knee Surgery Shows No Benefit and May Be Harmful in 10-Year Follow-Up Study

A 10-year follow-up of the FIDELITY placebo-surgery controlled trial published in the New England Journal of Medicine found that partial meniscectomy, one of the world's most common orthopedic surgeries, provides no benefit for degenerative meniscal tears and may cause harm. The study of 146 patients showed those receiving actual surgery had worse symptoms, reduced function, increased osteoarthritis progression, and higher rates of subsequent knee surgery compared to sham surgery patients. Despite this evidence and recommendations from independent clinical guideline organizations for nearly a decade to discontinue the procedure, partial meniscectomy remains widely performed internationally, with the American Academy of Orthopaedic Surgeons and British Association for Surgery of the Knee continuing to endorse it. Finland has significantly reduced the procedure, while principal investigators Teppo Järvinen and Raine Sihvonen argue the surgery is based on the outdated assumption that knee pain stems from meniscus tears rather than age-related degeneration.

Long-term ineffectiveness and potential harms of partial meniscectomy

• ▪Partial meniscectomy did not improve patients' symptoms or function compared to sham surgery in the 10-year FIDELITY study follow-up
• ▪The FIDELITY study randomized patients with degenerative meniscal tears to undergo either partial meniscectomy or sham surgery
• ▪More than 90% of the original 146 FIDELITY study participants took part in the final 10-year follow-up stage
• ▪Several randomized studies have demonstrated that partial meniscectomy has not improved patients' symptoms or function in the short term of 1-2 years
• ▪Patients who underwent partial meniscectomy had more symptoms at 10-year follow-up compared to sham surgery patients
• ▪The FIDELITY study is a 10-year follow-up of a placebo-surgery controlled trial published in the New England Journal of Medicine

Flawed medical assumptions underlying the surgery

• ▪Teppo Järvinen is a Professor at the University of Helsinki and the principal investigator of the FIDELITY study
• ▪The number of partial meniscectomy procedures in Finland has decreased significantly in recent years
• ▪Raine Sihvonen is a Specialist in Orthopedics and Traumatology and a principal investigator of the FIDELITY study
• ▪Partial meniscectomy is one of the most common orthopedic surgeries in the world
• ▪Partial meniscectomy surgery is based on the assumption that pain in the inside of the knee is caused by a medial meniscus tear

Resistance to discontinuing ineffective procedures despite evidence

• ▪Partial meniscectomy has remained widely used in many countries despite randomized studies showing no improvement in symptoms or function
• ▪The American Academy of Orthopaedic Surgeons has continued to endorse partial meniscectomy surgery
• ▪The British Association for Surgery of the Knee has continued to endorse partial meniscectomy surgery
• ▪The FIDELITY study was conducted in five hospitals as a multicenter collaboration
• ▪Many independent, non-orthopedic organizations providing clinical guidelines have recommended that partial meniscectomy should be discontinued for nearly a decade
• ▪Partial meniscectomy continues to be performed widely internationally despite evidence of ineffectiveness

Perspective of FIDELITY study investigators (Teppo Järvinen and Raine Sihvonen)

• ▪The FIDELITY study investigators believe their 10-year follow-up provides definitive evidence against partial meniscectomy surgery

Perspective of American Academy of Orthopaedic Surgeons and British Association for Surgery of the Knee

• ▪The British Association for Surgery of the Knee maintains support for partial meniscectomy despite independent organizations recommending discontinuation
• ▪The American Academy of Orthopaedic Surgeons maintains support for partial meniscectomy despite independent organizations recommending discontinuation