Knee arthroscopies: who gets them, what does the radiologist report, and what does the surgeon find?

Abstract

Background and purposeSeveral randomized controlled trials have not shown any added benefit of arthroscopy over placebo surgery or physiotherapy in middle-aged patients with knee symptoms without trauma. We studied the characteristics of the knee arthroscopies performed in southern Sweden.Patients and methodsFrom the orthopedic surgical records from 2007–2009 in the Skåne region of Sweden (with a population of 1.2 million), we retrieved ICD-10 diagnostic codes and selected all 4,096 arthroscopies that were diagnosed peroperatively with code M23.2 (derangement of meniscus due to old tear or injury) or code M17 (knee osteoarthritis). We extracted information on cartilage and meniscus status at arthroscopy, and we also randomly sampled 502 of these patients from the regional archive of radiology and analyzed the preoperative prevalence of radiographic or magnetic resonance imaging (MRI)-defined osteoarthritis.Results2,165 (53%) of the 4,096 arthroscopies had the diagnostic code M23.2 or M17. In this subgroup, 1,375 cases (64%) had typical findings consistent with degenerative meniscal tear (i.e. that correspond to a degenerative meniscal tear in at least a third of all arthroscopies). Of the randomly sampled patients, the preoperative prevalence of radiological knee osteoarthritis was 46%.InterpretationThere is a discrepancy between evidence-based medicine treatment guidelines and clinical practice regarding the amount of knee arthroscopies performed in patients with symptoms of degenerative knee disease.

Conundrum of mechanical knee symptoms: signifying feature of a meniscal tear?

“…This tear type is strongly associated with acute knee trauma and therefore more prevalent in younger sports-active patients 23. Our age-stratified analysis did not indicate any association between meniscal tears (at large) and mechanical symptoms among patients aged 18–40 years.…”

Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

“…2008, Bergkvist et al. 2016). Most of these patients have degenerative meniscal tears (Thorlund et al.…”

“…A recent registry-based study including information from plain radiographs, MRI, and arthroscopy found that about one-third of knee arthroscopies in Sweden were performed on patients with degenerative meniscal tears and/or osteoarthritis (Bergkvist et al. 2016). This is despite the fact of systematic reviews reporting no added benefit of surgery over that of placebo or additional effect of surgery in addition to exercise therapy for patients with early signs of knee osteoarthritis (OA) (i.e.…”

“…2008, Bergkvist et al. 2016). Detailed information about meniscal tear pattern and other knee pathology collected at arthroscopy can help characterize patients who undergo meniscal surgery.…”

Meniscal resection may not benefit patients with traumatic meniscal tears

“…Over half of these are performed to treat a meniscus tear in a degenerative knee 1. However, several recent randomised trials have shown that APM is not superior to conservative treatment or placebo treating meniscus tears associated with a degenerative knee 2…”