Knee pain is a very common problem, especially as people get older. One of the most frequent causes is damage to a structure in the knee called the meniscus.
The meniscus is a piece of cartilage that acts like a cushion between the bones. When it becomes worn or torn over time, it can cause pain, stiffness, and difficulty moving.
For many years, doctors have treated this condition with a surgery called partial meniscectomy. In this procedure, the damaged part of the meniscus is trimmed away.
It is one of the most common orthopedic surgeries in the world, and millions of people have had it. The idea behind the surgery is simple: remove the damaged tissue to reduce pain and improve movement.
However, a major new study suggests that this approach may not work as expected. Researchers have followed patients for 10 years after surgery and found that the results are not only disappointing but may even be harmful.
The study was published in the New England Journal of Medicine and is part of the Finnish Degenerative Meniscal Lesion Study, known as FIDELITY.
What makes this study special is how it was designed. Instead of simply comparing surgery to no treatment, the researchers used something called a sham surgery.
This means that some patients went through a fake procedure where they believed they had surgery, but no actual trimming of the meniscus was done. This type of study helps remove the effect of expectations and provides a clearer picture of whether the surgery itself truly works.
The study included patients with degenerative meniscal tears, which are caused by aging rather than injury. Participants were randomly assigned to receive either real surgery or sham surgery. They were then followed over many years to track their symptoms, knee function, and overall health.
After 10 years, the results were clear. Patients who had the actual surgery did not report better outcomes than those who had the sham procedure. In fact, they often had worse results. They experienced more pain, reduced function, and a higher risk of developing osteoarthritis, a condition where the joint becomes worn and painful over time.
The study also found that patients who underwent the surgery were more likely to need additional knee procedures later. This raises concerns about whether the surgery might be causing more harm than benefit in the long run.
Researchers say these findings challenge long-held beliefs about the cause of knee pain. Many doctors have assumed that a torn meniscus is the main source of pain and that removing the damaged tissue would solve the problem.
However, the study suggests that the pain may instead be related to overall joint degeneration, which is part of the natural aging process.
This type of finding is sometimes called a “medical reversal.” It happens when a widely used treatment is later found to be ineffective or even harmful after better research is conducted. According to the researchers, partial meniscectomy may be an example of this.
Previous studies had already shown that the surgery did not provide significant benefits in the short or medium term. However, it has continued to be widely performed in many countries. This highlights how difficult it can be to change medical practice, even when new evidence becomes available.
There are also concerns about possible risks linked to the surgery. Some observational studies have suggested that patients who undergo partial meniscectomy may have a higher chance of needing joint replacement surgery in the future. While these earlier studies could not prove cause and effect, the new long-term trial provides stronger evidence.
The researchers also note the high quality of the study. It involved multiple hospitals and had a very high follow-up rate, with more than 90 percent of participants completing the 10-year assessment. This strengthens confidence in the findings.
In conclusion, this study suggests that partial meniscectomy may not be the best option for people with degenerative meniscus tears. It may not improve symptoms and could increase the risk of long-term problems. The findings support growing calls to reduce the use of this surgery and focus more on non-surgical treatments.
Overall, the study highlights the importance of high-quality research in guiding medical decisions. It shows that even widely accepted treatments need to be carefully tested and re-evaluated over time.
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