According to the research conducted by University of Helsinki researchers, keyhole surgeries of the knee are useless for patients whose knee complaints are due to joint abnormalities associated with aging.


The Finnish Degenerative Meniscal Lesion Study (FIDELITY) was designed to determine whether keyhole surgery to partially remove the meniscus (arthroscopic meniscal resection) is an effective form of treatment when the tear is caused by degeneration.

The study focused on two groups of patients between the ages of 35 and 65, comparing the results of knee surgery with placebo surgeries in which the patients’ knees were probed but damaged areas were not removed.

In both groups, most patients were satisfied with the status of their knee and believed their knee felt better than before the procedure. Of the patients who underwent the partial meniscectomy, 93% would choose the same treatment, while 96% of those in the placebo group would choose the same.

University of Helsinki and the Helsinki University Central Hospital, adjunct professor Teppo Järvinen and Raine Sihvonen, a specialist in orthopedics and traumatology from Hatanpää Hospital in Tampere said these results show that surgery is not an effective form of treatment in such cases.

"It’s difficult to imagine that such a clear result would result in no changes to treatment practices," they added.

"This operation has become the most common orthopedic surgical procedure, or in fact any surgical procedure next to cataract surgery, in nearly all Western countries. Nearly 12,000 partial meniscectomies are done in Finland every year. In the United States, the number is close to a million," Sihvonen added.

Recently, a randomized trial showed that arthroscopic partial meniscectomy combined with physical therapy provides no better relief of symptoms than physical therapy alone in patients with a meniscal tear and knee osteoarthritis.

"Based on these results, we should question the current line of treatment according to which patients with knee pain attributed to a degenerative meniscus tear are treated with partial removal of the meniscus, as it seems clear that instead of surgery, the treatment of such patients should hinge on exercise and rehabilitation," Järvinen added.

"By ceasing the procedures which have proven ineffective, we would avoid performing 10,000 useless surgeries every year in Finland alone. The corresponding figure for US is at least 500,000 surgeries," Sihvonen added.

The FIDELITY research project includes the Helsinki University Central Hospital, the Kuopio and Turku University Hospitals, the Hatanpää Hospital in Tampere, the Central Finland Central Hospital and the National Institute for Health and Welfare.

The study was published in the New England Journal of Medicine.

Image: Dr Raine Sihvonen performing arthroscopic knee surgery at the Hatanpää Hospital, Tampere. Photo: courtesy of Anri Sormunen.