Objective To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus. Methods In this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35–65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out. Results In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, −4.3; 95% CI, −11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (−3.2; −8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (−0.4; −1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups. Conclusions In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.

中文翻译：

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关节镜下半月板部分切除术与安慰剂手术治疗退行性半月板撕裂：随机对照试验的 2 年随访

目的评估关节镜下半月板部分切除术（APM）在治疗内侧半月板退行性撕裂患者方面是否优于安慰剂手术。方法 在这项多中心、随机、参与者盲法和结果评估者盲法、安慰剂手术对照试验中，146 名年龄在 35-65 岁之间、膝关节症状与退行性内侧半月板撕裂一致且无膝关节骨关节炎的成年人随机接受 APM 或安慰剂治疗手术。主要结果是西安大略半月板评估工具 (WOMET) 和 Lysholm 膝关节评分和手术后 24 个月运动后膝关节疼痛相对于基线变化的组间差异。次要结果包括治疗组分配揭盲的频率、参与者的满意度、变化的印象、恢复正常活动、严重不良事件的发生率和临床检查中半月板症状的存在。还进行了两个亚组分析，评估了有机械症状的人和有不稳定半月板撕裂的人的结果。结果 在意向治疗分析中，WOMET 评分从基线到 24 个月的平均变化没有显着组间差异：APM 组为 27.3，而安慰剂手术组为 31.6（组间差异，-4.3；95% CI，-11.3 至 2.6）；Lysholm 膝关节评分：分别为 23.1 和 26.3（-3.2；-8.9 至 2.4）或运动后膝关节疼痛，分别为 3.5 和 3.9（-0.4；-1.3 至 0.5）。在任何次要结果或分析的亚组内，两组之间没有统计学上的显着差异。结论 在对没有膝关节骨关节炎但有退行性内侧半月板撕裂症状的患者进行的为期 2 年的随访中，APM 后的结果并不比安慰剂手术后的结果好。没有证据支持存在机械症状或某些半月板撕裂特征的患者或初始保守治疗失败的患者更有可能从 APM 中受益的流行观点。