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Knee arthroscopy: evidence for a targeted approach
  1. Robert F LaPrade1,
  2. Tim Spalding2,
  3. Iain R Murray3,4,
  4. Jorge Chahla5,
  5. Marc R Safran3,
  6. Christopher M Larson1,
  7. Scott C Faucett6,
  8. Richard von Bormann7,
  9. Robert H Brophy8,
  10. Rodrigo Maestu9,
  11. Aaron J Krych10,
  12. Ponky Firer11,
  13. Lars Engebretsen12
  1. 1Twin Cities Orthopaedics, Edison, Minnesota, USA
  2. 2Department of Trauma and Orthopaedics, University Hospital Coventry, Coventry, UK
  3. 3Department of Orthopaedic Sports Medicine, Stanford University, Redwood City, California, USA
  4. 4Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
  5. 5Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Ilinois, USA
  6. 6Centers for Advanced Orthopaedics, Washington, District of Columbia, USA
  7. 7Cape Town Sports & Orthopaedic Clinic, Cape Town, South Africa
  8. 8Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
  9. 9Centro de Tratamiento de Enfermedades Articulares, Buenos Aires, Argentina
  10. 10Department of Orthoapedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
  11. 11Linksfield Orthopaedic Sports and Rehabilitation Centre, Johannesburg, South Africa
  12. 12Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Robert F LaPrade, Twin Cities Orthopedics, Edison, Minnesota, USA; robertlaprade{at}tcomn.com

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Like many areas of medicine, the role of arthroscopy is evolving and its use must be guided by critical analysis of the scientific evidence. Data evaluating arthroscopic knee surgery is complex with heterogenous pathology, patient populations and techniques and, therefore, must be interpreted with care. Attention-grabbing headlines and animations can stimulate discussion, but when key aspects of published science are overlooked, they risk oversimplification. We believe a number of articles published in a recent edition of the British Journal of Sports Medicine (BJSM) represent examples where science may be overshadowed by oversimplification. Thus, we offer additional insights to focus the place of arthroscopy in the management of joint problems.

Oversimplification can be misleading

To our interpretation, recent BJSM publications appear to take an emotional stance, indicating that all arthroscopy for conditions that cause joint pain is bad and should be stopped.1 2 Following an article reporting a decline in the rate of arthroscopy in Finland,3 Ardern et al provided a provocative editorial citing reasons for this change as reduced reimbursement, medical overuse and grass roots pressure.1 Scientific evidence was not one of the five reasons given directly.

An editorial by Engebretsen and Moatshe4 in the same edition provides a more balanced discussion on the 5-year results of the Finnish Degenerative Meniscus Lesion Study (FIDELITY) trial also published in the same issue.5 This editorial contends that the conclusion by Sihvonen and colleagues that arthroscopic partial meniscectomy is associated with a greater risk of …

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Footnotes

  • Twitter @larsengebretsen

  • Contributors All authors contributed to this work (editing and crafting the work).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RFL is a consultant for Arthrex, Ossur, Smith and Nephew and Linvatec; receives royalties from Arthrex, Ossur, Smith & Nephew, and Elsevier; Editorial Boards of AJSM, JEO and KSSTA. TS is a consultant for Conmed, Episurf and has an Educational contract with Smith & Nephew. IRM is on the Editorial board for The Bone and Joint Journal and Bone and Joint Research. JC is a consultant for Smith & Nephew, Arthrex, CONMED, Ossur and receives royalties for Elsevier. MS is a consultant for Smith & Nephew and Medacta; Royalties from Smith & Nephew. CL is a consultant for Smith & Nephew. SF is a consultant for Smith & Nephew, Trice, Artoss and Allosource; Editorial board for Arthroscopy. RVB is a consultant for Smith & Nephew. RHB is a Deputy Editor for JAAOS. RM is a consultant Smith & Nephew and Stryker; Editorial Board Revista Artroscopia. AJK is a consultant and receives royalties from Arthrex. LE is a consultant and receives royalties from Arthrex and Smith & Nephew; Editorial board for BJSM.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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