TY - JOUR T1 - Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial JF - British Journal of Sports Medicine JO - Br J Sports Med DO - 10.1136/bjsports-2020-102813 SP - bjsports-2020-102813 AU - Raine Sihvonen AU - Mika Paavola AU - Antti Malmivaara AU - Ari Itälä AU - Antti Joukainen AU - Juha Kalske AU - Heikki Nurmi AU - Jaanika Kumm AU - Niko Sillanpää AU - Tommi Kiekara AU - Aleksandra Turkiewicz AU - Pirjo Toivonen AU - Martin Englund AU - Simo Taimela AU - Teppo Järvinen A2 - , Y1 - 2020/08/27 UR - http://bjsm.bmj.com/content/early/2020/08/27/bjsports-2020-102813.abstract N2 - Objectives To assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at 5 years follow-up.Design Multicentre, randomised, participant- and outcome assessor-blinded, placebo-surgery controlled trial.Setting Orthopaedic departments in five public hospitals in Finland.Participants 146 adults, mean age 52 years (range 35–65 years), with knee symptoms consistent with degenerative medial meniscus tear verified by MRI scan and arthroscopically, and no clinical signs of knee osteoarthritis were randomised.Interventions APM or placebo surgery (diagnostic knee arthroscopy).Main outcome measures We used two indices of radiographic knee osteoarthritis (increase in Kellgren and Lawrence grade ≥1, and increase in Osteoarthritis Research Society International (OARSI) atlas radiographic joint space narrowing and osteophyte sum score, respectively), and three validated patient-relevant measures of knee symptoms and function (Western Ontario Meniscal Evaluation Tool (WOMET), Lysholm, and knee pain after exercise using a numerical rating scale).Results There was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the APM group as compared with the placebo surgery group (adjusted absolute risk difference in increase in Kellgren-Lawrence grade ≥1 of 13%, 95% CI −2% to 28%; adjusted absolute mean difference in OARSI sum score 0.7, 95% CI 0.1 to 1.3). There were no relevant between-group differences in the three patient-reported outcomes: adjusted absolute mean differences (APM vs placebo surgery), −1.7 (95% CI −7.7 to 4.3) in WOMET, −2.1 (95% CI −6.8 to 2.6) in Lysholm knee score, and −0.04 (95% CI −0.81 to 0.72) in knee pain after exercise, respectively. The corresponding adjusted absolute risk difference in the presence of mechanical symptoms was 18% (95% CI 5% to 31%); there were more symptoms reported in the APM group. All other secondary outcomes comparisons were similar.Conclusions APM was associated with a slightly increased risk of developing radiographic knee osteoarthritis and no concomitant benefit in patient-relevant outcomes, at 5 years after surgery.Trial registration ClinicalTrials.gov (NCT01052233 and NCT00549172). ER -