Criticism of NEJM Flawed Meniscectomy Study

medical_meniscectomyLet’s take a closer look at the recent New England Journal of Medicine article on arthroscopic partial meniscectomy, says Brian Cole, M.D. Dr. Cole, Professor in the Departments of Orthopaedic Surgery and Anatomy & Cell Biology at Rush University Medical Center, tells OTW, “There are a number of problems with this study. It took five years to enroll patients in the study, so there should have been a denominator among the five sites of several thousand potential meniscectomy patients in the practices of the investigators. In fact there were less than 200 enrolled; add to that the fact that almost 25% were dropped from the study. Then there is the issue that these were not acute, dramatic tears…they were degenerative menisci. This brings into question the generalization of the population studied to the population at large with acute and chronic meniscal tears.”

“And their conclusion that ‘arthroscopic partial meniscectomy is of no value’ is not what the study showed. They looked at two surgical procedures, that had the common factor of irrigation and lavage with the only difference being one group underwent a concomitant debridement of the meniscus. If you want to know the impact of the different aspects of the treatment then a true ‘sham’ group would be needed where an incision is made without entering the joint. That said, both groups improved with surgery compared to their baseline clinical presentation.”

“Let’s say that the study had been appropriately powered. Then you can say that doing something to the meniscus may or may not make a difference. But arthroscopy did seem to make things better. It is a nuance because half of the patients had the meniscus treated and half did not…and these are degenerative, not traumatic, injuries.”

“I do congratulate the authors for the rigor in which the study was performed. I share concerns, however, with other orthopedic surgeons that this study could cause problems. If policy makers or insurers take the message away that surgery for meniscal tears isn’t effective when in fact this and several other studies have shown that it is effective when appropriately indicated, then I worry that coverage decisions may be erroneously made.”

Published in Orthopedics This Week – January 14, 2014

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