Arthroscopic partial meniscectomy: did it ever work?: A narrative review from basic research to proposed disease framework and science of clinical practice

Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the l...

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Autores principales:	Aleksi Reito, Ian A Harris, Teemu Karjalainen
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/90e2f469e2c041ffbefaab740156ab36
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spelling	oai:doaj.org-article:90e2f469e2c041ffbefaab740156ab362021-11-04T15:00:42ZArthroscopic partial meniscectomy: did it ever work?: A narrative review from basic research to proposed disease framework and science of clinical practice1745-36741745-368210.1080/17453674.2021.1979793https://doaj.org/article/90e2f469e2c041ffbefaab740156ab362021-09-01T00:00:00Zhttp://dx.doi.org/10.1080/17453674.2021.1979793https://doaj.org/toc/1745-3674https://doaj.org/toc/1745-3682Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT? A truly effective treatment needs a valid disease model that would biologically and plausibly explain the perceived treatment benefits. In the case of DMT, effectiveness requires a credible framework for the pain-generating process, which should be influenced by APM. Basic research, pathoanatomy, and clinical evidence gives no support to these frameworks. Moreover, treatment of DMT with an APM does not align with the traditional practice of medicine since DMT is not a reliable diagnosis for knee pain and no evidence-based indication exists that would influence patient prognosis from APM. A plausible and robust explanation supported by both basic research and clinical evidence is that DMTs are part of an osteoarthritic disease process and do not contribute to the symptoms independently or in isolation and that symptoms are not treatable with APM. This is further supported by the fact that APM as an intervention is paradoxical because the extent of procedure and severity of disease are both inversely associated with outcome. We argue that arthroscopic treatment of DMT is largely based on a logical fallacy: post hoc ergo propter hoc.Aleksi ReitoIan A HarrisTeemu KarjalainenTaylor & Francis GrouparticleOrthopedic surgeryRD701-811ENActa Orthopaedica, Vol 0, Iss 0, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 Aleksi Reito Ian A Harris Teemu Karjalainen Arthroscopic partial meniscectomy: did it ever work?: A narrative review from basic research to proposed disease framework and science of clinical practice
description	Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT? A truly effective treatment needs a valid disease model that would biologically and plausibly explain the perceived treatment benefits. In the case of DMT, effectiveness requires a credible framework for the pain-generating process, which should be influenced by APM. Basic research, pathoanatomy, and clinical evidence gives no support to these frameworks. Moreover, treatment of DMT with an APM does not align with the traditional practice of medicine since DMT is not a reliable diagnosis for knee pain and no evidence-based indication exists that would influence patient prognosis from APM. A plausible and robust explanation supported by both basic research and clinical evidence is that DMTs are part of an osteoarthritic disease process and do not contribute to the symptoms independently or in isolation and that symptoms are not treatable with APM. This is further supported by the fact that APM as an intervention is paradoxical because the extent of procedure and severity of disease are both inversely associated with outcome. We argue that arthroscopic treatment of DMT is largely based on a logical fallacy: post hoc ergo propter hoc.
format	article
author	Aleksi Reito Ian A Harris Teemu Karjalainen
author_facet	Aleksi Reito Ian A Harris Teemu Karjalainen
author_sort	Aleksi Reito
title	Arthroscopic partial meniscectomy: did it ever work?: A narrative review from basic research to proposed disease framework and science of clinical practice
title_short	Arthroscopic partial meniscectomy: did it ever work?: A narrative review from basic research to proposed disease framework and science of clinical practice
title_full	Arthroscopic partial meniscectomy: did it ever work?: A narrative review from basic research to proposed disease framework and science of clinical practice
title_fullStr	Arthroscopic partial meniscectomy: did it ever work?: A narrative review from basic research to proposed disease framework and science of clinical practice
title_full_unstemmed	Arthroscopic partial meniscectomy: did it ever work?: A narrative review from basic research to proposed disease framework and science of clinical practice
title_sort	arthroscopic partial meniscectomy: did it ever work?: a narrative review from basic research to proposed disease framework and science of clinical practice
publisher	Taylor & Francis Group
publishDate	2021
url	https://doaj.org/article/90e2f469e2c041ffbefaab740156ab36
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Arthroscopic partial meniscectomy: did it ever work?: A narrative review from basic research to proposed disease framework and science of clinical practice

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