There is increasing evidence that arthroscopic partial meniscectomies, one of the most common surgical procedures performed on the knee, may not be as effective as previously thought. This edition of the FastFact highlights the five-year results of the FIDELITY trial which have just been published in the BJSM.
The aim of the FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial is to assess the longer-term effects of arthroscopic partial medial meniscectomy. This paper highlights the five-year results of this placebo-surgery controlled trial. To be included in the trial patients were required to have a degenerative medial meniscal tear (based on clinical findings and the results of both an MRI and surgical findings). They were then randomised to having either an arthroscopic partial meniscectomy or a diagnostic arthroscopy (placebo). The participants, all caregivers, and those assessing the outcomes were blinded to the treatment assignment. In total 146 adults with a mean age of 52 years participated in the study.
The studies outcome measures included radiological measure of knee osteoarthritis (including the Kellegren and Lawrence grade and Osteoarthritis Research Society International scores) and a number of patient-reported outcome scores (including the Western Ontario Meniscal Evaluation Tool, Lysholm knee score and knee pain after exercise). Patients who had undergone an osteotomy or a total knee replacement during the five-year follow-up period were considered to have progressed radiographically.
At five-year follow-up participants in the intervention group (who had a partial meniscectomy) had a very slightly increased risk of radiographic knee osteoarthritis. It is hard to know whether this is clinically significant. What may be more important to the patient is that they did not appear to have gained any additional benefit from their surgery on their knee pain, other symptoms or function compared with placebo surgery.
The result of this study suggest that clinicians should exercise caution when considering referring older players for an arthroscopy. It is however important to highlight that this study does have some limitations, especially when considering a football playing population. It does not include younger people (age range 35-65 years) or those with a traumatic meniscal tear. As a result, the results of this study are not likely to be generalisable to elite players or many younger players.
1. Sihvonen R, Paavola M, Malmivaara A, et al Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial British Journal of Sports Medicine Published Online First: 27 August 2020. doi: 10.1136/bjsports-2020-102813