Association Between Baseline Meniscal Symptoms and Outcomes of Operative and Nonoperative Treatment of Meniscal Tear in Patients With Osteoarthritis

MacFarlane, Lindsey A.; Yang, Henry C.; Collins, Jamie E.; Brophy, Robert H.; Cole, Brian J.; Spindler, Kurt P.; Guermazi, Ali; Jones, Morgan; Mandl, Lisa A.; Martin, Scott D.; Marx, Robert G.; Levy, Bruce A.; Stuart, Michael J.; Safran‐Norton, Clare E.; Wright, John; Wright, Rick W.; Losina, Elena; Katz, Jeffrey N.

doi:10.1002/acr.24588

Cited by 8 publications

(5 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Routine use of an MRI for diagnosis of degenerative knee disease is not recommended for this specific patient group due to the poor association with symptoms [ 13 , 20 , 21 , 32 ]. Similarly, arthroscopic interventions are not recommended for routine use in degenerative knee disease because limited benefits are found that are absent 1 to 2 years after surgery [ 16 , 27 , 28 , 39 , 40 , 43 ]. Only when locking symptoms are present, a knee arthroscopy may be warranted.…”

Section: Introductionmentioning

confidence: 99%

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

Rietbergen

Mheen

Graaf

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). Methods All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI’s and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016–June 2017) and after introduction of the intervention (July 2017–December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. Results 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = − 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = − 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = − 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). Conclusions The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. Level of evidence III.

show abstract

Section: Introductionmentioning

confidence: 99%

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

Rietbergen

Mheen

Graaf

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…More importantly, no clinical study supports the proposition that occurrence of DMT would result in knee pain or that DMT is a defined independent clinical entity. In fact, clinical studies show that development of knee pain is not associated with the development of DMT and that “meniscal symptoms” are merely a correlate for cartilage damage (Bhattacharyya et al 2003 , Englund et al 2007 , Hare et al 2017 , MacFarlane et al 2021 ).…”

Section: Disease Framework: Can We Explain Pain?mentioning

confidence: 99%

Arthroscopic partial meniscectomy: did it ever work?

2021

View full text Add to dashboard Cite

Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT? A truly effective treatment needs a valid disease model that would biologically and plausibly explain the perceived treatment benefits. In the case of DMT, effectiveness requires a credible framework for the pain-generating process, which should be influenced by APM. Basic research, pathoanatomy, and clinical evidence gives no support to these frameworks. Moreover, treatment of DMT with an APM does not align with the traditional practice of medicine since DMT is not a reliable diagnosis for knee pain and no evidence-based indication exists that would influence patient prognosis from APM. A plausible and robust explanation supported by both basic research and clinical evidence is that DMTs are part of an osteoarthritic disease process and do not contribute to the symptoms independently or in isolation and that symptoms are not treatable with APM. This is further supported by the fact that APM as an intervention is paradoxical because the extent of procedure and severity of disease are both inversely associated with outcome. We argue that arthroscopic treatment of DMT is largely based on a logical fallacy: post hoc ergo propter hoc.

show abstract

“…Results were consistent at 5-year follow-up . While certain subgroups of patients may benefit from partial meniscectomy, often thought to be those with mechanical symptoms, secondary analyses from RCTs demonstrate that the presence of mechanical symptoms was not associated with improved pain relief …”

Section: Meniscal Tearsmentioning

confidence: 75%

Evaluation and Treatment of Knee Pain

Duong,

Oo,

Ding

et al. 2023

JAMA

View full text Add to dashboard Cite

ImportanceApproximately 5% of all primary care visits in adults are related to knee pain. Osteoarthritis (OA), patellofemoral pain, and meniscal tears are among the most common causes of knee pain.ObservationsKnee OA, affecting an estimated 654 million people worldwide, is the most likely diagnosis of knee pain in patients aged 45 years or older who present with activity-related knee joint pain with no or less than 30 minutes of morning stiffness (95% sensitivity; 69% specificity). Patellofemoral pain typically affects people younger than 40 years who are physically active and has a lifetime prevalence of approximately 25%. The presence of anterior knee pain during a squat is approximately 91% sensitive and 50% specific for patellofemoral pain. Meniscal tears affect an estimated 12% of the adult population and can occur following acute trauma (eg, twisting injury) in people younger than 40 years. Alternatively, a meniscal tear may be a degenerative condition present in patients with knee OA who are aged 40 years or older. The McMurray test, consisting of concurrent knee rotation (internal or external to test lateral or medial meniscus, respectively) and extension (61% sensitivity; 84% specificity), and joint line tenderness (83% sensitivity; 83% specificity) assist diagnosis of meniscal tears. Radiographic imaging of all patients with possible knee OA is not recommended. First-line management of OA comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition. Surgical referral for knee joint replacement can be considered for patients with end-stage OA (ie, no or minimal joint space with inability to cope with pain) after using all appropriate conservative options. For patellofemoral pain, hip and knee strengthening exercises in combination with foot orthoses or patellar taping are recommended, with no indication for surgery. Conservative management (exercise therapy for 4-6 weeks) is also appropriate for most meniscal tears. For severe traumatic (eg, bucket-handle) tears, consisting of displaced meniscal tissue, surgery is likely required. For degenerative meniscal tears, exercise therapy is first-line treatment; surgery is not indicated even in the presence of mechanical symptoms (eg, locking, catching).Conclusions and RelevanceKnee OA, patellofemoral pain, and meniscal tears are common causes of knee pain, can be diagnosed clinically, and can be associated with significant disability. First-line treatment for each condition consists of conservative management, with a focus on exercise, education, and self-management.

show abstract

Association Between Baseline Meniscal Symptoms and Outcomes of Operative and Nonoperative Treatment of Meniscal Tear in Patients With Osteoarthritis

Cited by 8 publications

References 25 publications

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

Arthroscopic partial meniscectomy: did it ever work?

Evaluation and Treatment of Knee Pain

Contact Info

Product

Resources

About