Department of Orthopedics and Traumatology, Hatanpää Hospital, Tampere, Finland.
Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.
Ann Rheum Dis. 2018 Feb;77(2):188-195. doi: 10.1136/annrheumdis-2017-211172. Epub 2017 May 18.
To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus.
In this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35-65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out.
In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, -4.3; 95% CI, -11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (-3.2; -8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (-0.4; -1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups.
In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.
评估关节镜下半月板部分切除术（APM）治疗内侧半月板退行性撕裂患者是否优于安慰剂手术。
在这项多中心、随机、参与者盲法和结果评估者盲法、安慰剂手术对照试验中，招募了 146 名年龄在 35-65 岁之间、有膝关节症状符合内侧半月板退行性撕裂且无膝关节骨关节炎的成年人，将他们随机分为 APM 或安慰剂手术组。主要结局是术后 24 个月时，两组间从基线变化的 Western Ontario 半月板评估工具（WOMET）和 Lysholm 膝关节评分以及运动后膝关节疼痛之间的差异。次要结局包括治疗组分配的揭盲频率、参与者的满意度、印象改变、恢复正常活动、严重不良事件的发生率以及临床检查中半月板症状的存在。还进行了两项亚组分析，评估有机械症状和半月板不稳定撕裂的患者的结局。
在意向治疗分析中，APM 组和安慰剂手术组在 WOMET 评分的平均变化方面没有显著的组间差异：APM 组为 27.3，安慰剂手术组为 31.6（组间差异，-4.3；95%CI，-11.3 至 2.6）；Lysholm 膝关节评分：分别为 23.1 和 26.3（-3.2；-8.9 至 2.4）或运动后膝关节疼痛，分别为 3.5 和 3.9（-0.4；-1.3 至 0.5）。两组在任何次要结局或分析亚组中均无统计学差异。
在这项对没有膝关节骨关节炎但有内侧半月板退行性撕裂症状的患者进行的 2 年随访中，APM 后的结果并不优于安慰剂手术。没有证据支持普遍认为的观点，即有机械症状或某些半月板撕裂特征的患者或那些最初保守治疗失败的患者更可能从 APM 中获益。
