BASK response to media reports on arthroscopic knee meniscectomy surgery research letter
The Guardian newspaper has published an article on the results of a 10-year study on arthroscopic knee meniscectomy surgery for a meniscus tear. The findings of the report suggest that the surgery does not benefit all patients equally.
Mark Bowditch, consultant knee surgeon and immediate past president of the British Orthopaedic Association, said in the article that best practice guidelines had changed in the last 15 years to reflect evidence concerns about the limited benefits of meniscectomy surgery in this group of middle aged or old patients. This included extending the recommended waiting period to see whether symptoms resolved with non operative treatment and physiotherapy, and more targeted surgical indications.
“In the past, three-quarters of patients might have had surgery, but now it’s [closer to a quarter],” he said. “ For these degenerative tears we have an approach of ‘think before you strike’. Surgery should usually not be the first step.”
However, he said there were subsets of patients who may still benefit, based on his clinical experience. “If you’re operating to treat pain, that is can be unpredictable,” he said. “But there’s a group who have may have repairable tears or a mechanical sensation of something catching – that may have a more predictable benefit.”
In response to the article the British Association for Surgery of the Knee (BASK) has said it welcomes the long-term follow-up of this research but is concerned that the reporting does not reflect the limited scope of the study population, and that patients who genuinely need surgery may now delay or decline treatment on the basis of findings that do not apply to their condition.
BASK states that the study examined one specific type of patient: those with degenerative meniscal tears arising from wear and tear, in middle age, with no injury history and no joint locking. It excluded, by design, patients with traumatic or injury-related tears and those with true mechanical locking. These are precisely the patients in whom surgery is most clearly beneficial, and the study cannot and should not be used to guide their treatment.
The BASK letter to the Editor of the Guardian in response to the article and a summary statement are available below: