Arthroscopy for degenerate meniscal tears of the kneeBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2382 (Published 02 April 2014) Cite this as: BMJ 2014;348:g2382
- Andrew Price, professor of orthopaedic surgery and consultant knee surgeon1,
- David Beard, professor of musculoskeletal sciences and codirector RCS Surgical Trials Unit (Oxford)1
- 1Botnar Institute of Musculoskeletal Sciences, NIHR Oxford Biomedical Research Unit, OUH NHS Trust, University of Oxford, Oxford OX3 7LD, UK
The NHS performs around 150 000 arthroscopic knee operations a year, with more than half involving resection of the meniscus. Therefore, close scrutiny of this intervention in the United Kingdom is entirely appropriate, particularly in the context of the ongoing drive towards providing evidence based and value based care.
Considering such high rates of surgery, it would be natural to assume that this operation is backed up by adequate evidence. However, unlike knee replacement surgery, which is supported by population based patient reported outcomes (PROMs) data and the National Joint Registry, healthcare commissioners lack the necessary data to allow informed decision making for knee arthroscopy. Detailed indications for its use need further refinement. With this backdrop, any results from high quality randomised controlled trials in this area are welcome.
The recent study by Sihvonen and colleagues therefore makes interesting reading.1 In 2005, when the trial was started, investigators were worried about the increasing numbers of arthroscopic meniscectomies performed for patients with degenerative meniscal tears. At this time it was common …