According to prevailing consensus, patients with mechanical symptoms
are those considered to most likely benefit from arthroscopic surgery.
The aim of this study was to determine the value of using patients'
pre-operative self-reports of mechanical symptoms as a justification
surgery in patients with degenerative meniscus tear/knee disease.
A pragmatic
prospective cohort of 900 consecutive patients with symptomatic
degenerative knee disease and meniscus tear underwent arthroscopic
partial meniscectomy (APM) during 2007–2011.
The patients' subjective satisfaction, self-rated improvement, change in
Western Ontario Meniscal Evaluation Tool (WOMET) score, and patients'
ratings of the knee using a numerical rating scale (NRS) was assessed at
1 year postoperatively. Multivariable regression models, adjusted for
possible confounders and intermediates, were used to compare the
outcomes in those with and without preoperative mechanical symptoms.
The
proportion of patients satisfied with their knee 12 months after
arthroscopy was significantly lower among those with preoperative
mechanical symptoms than among those without (61% vs 75%, multivariable
adjusted risk ratio [RR] 0.84; 95% confidence interval [CI] 0.76, 0.92).
Similarly, the proportion reporting improvement was lower (RR 0.91; 95%
CI 0.85, 0.97). No statistically significant difference was found in
change in WOMET or NRS between the two groups. Of those with
preoperative mechanical symptoms, 47% reported persistent symptoms at 12
months postoperatively.
Findings contradict the current tenet of using patients'
self-report of mechanical symptoms as a justification for performing
arthroscopic surgery on patients with degenerative meniscus tear.
