A recent article summarised the evidence on treatment of meniscal tear; ‘torn cartilage’. Four RCTs have compared keyhole surgery with non-surgical care. Three found null results, and one documented an advantage for surgery. One fifth of control patients in the three null trials crossed over to the surgery group. Assuming they were worse prognosis patients, then this would make it harder for surgery to show a benefit on an intention-to-treat analysis (i.e. an analysis by assigned group rather than the treatment they actually received). Per protocol analysis (a potentially biased comparison based on treatment given) finds a benefit for surgery across these three studies. In the round, the data suggests a small advantage for surgery. Surgery should certainly be an option for patients with ongoing knee pain and a ruptured meniscus on MRI.
— Richard Lilford, CLAHRC WM Director
- Sihvonen R, et al. Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial. Ann Intern Med. 2016; 164: 449-55.