The Finnish Degenerative Meniscal Lesion Study (FIDELITY) compared surgical treatment of degenerative meniscal tears to placebo surgery. A year after the procedure the study participants, both those in the group who underwent surgery and the ones in the placebo group, had an equally low incidence of symptoms and were satisfied with the overall situation of their knee.
The results of the trial have been published in the esteemed New England Journal of Medicine.
– These results show that surgery is not an effective form of treatment in such cases. It’s difficult to imagine that such a clear result would result in no changes to treatment practices, state adjunct professor Teppo Järvinen from the University of Helsinki and the Helsinki University Central Hospital, and Raine Sihvonen, a specialist in orthopaedics and traumatology from Hatanpää Hospital in Tampere.
Knee problems – ones associated both with trauma and with aging – are highly common and place a significant burden on the health care system. The most common diagnosis of the knee that requires treatment is a tear in the meniscus, for which the established form of treatment is the partial removal of the meniscus through keyhole surgery. Most of the treated meniscal tears are degenerative.
– This operation has become the most common orthopaedic surgical procedure in nearly all Western countries. Nearly 12,000 partial meniscectomies are done in Finland every year. In the United States, the number is close to a million, explains Sihvonen.
Previous randomised studies have shown that keyhole surgery on the knee does not alleviate the symptoms of patients who suffer from osteoarthritis. The goal of the FIDELITY trial was to determine whether keyhole surgery to partially remove the meniscus is an effective form of treatment when the tear is caused by degeneration.
The study included 146 participants, ranging between 35 and 65 years of age. The study participants were randomly assigned to undergo either an arthroscopic partial meniscectomy or placebo surgery where the procedure was simulated.
A year after the surgery, the patients were asked about the healing of the knee, symptoms they had experienced, as well as their satisfaction with the treatment and its results. In both groups, most patients were satisfied with the status of their knee and believed their knee felt better than before the procedure.
– Based on these results, we should question the current line of treatment according to which patients with knee pain attributed to a degenerative meniscus tear are treated with partial removal of the meniscus, as it seems clear that instead of surgery, the treatment of such patients should hinge on exercise and rehabilitation, Järvinen states.
The FIDELITY research project includes the Helsinki University Central Hospital, the Kuopio and Turku University Hospitals, the Hatanpää Hospital in Tampere, the Central Finland Central Hospital and the National Institute for Health and Welfare.