Objectives To examine the ability of surgeons to predict the outcome of treatment for meniscal tears by arthroscopic partial meniscectomy (APM) and exercise therapy in middle-aged patients. Design and setting Electronic survey. Orthopaedic surgeon survey participants were presented 20 patient profiles. These profiles were derived from a randomised clinical trial comparing APM with exercise therapy in middle-aged patients with symptomatic non-obstructive meniscal tears. From each treatment group (APM and exercise therapy), we selected five patients with the best (responders) and five patients with the worst (non-responders) knee function after treatment. 1111 orthopaedic surgeons and residents in the Netherlands and Australia were invited to participate in the survey. Interventions For each of the 20 patient profiles, surgeons (unaware of treatment allocation) had to choose between APM and exercise therapy as preferred treatment and subsequently had to estimate the expected change in knee function for both treatments on a 5-point Likert Scale. Finally, surgeons were asked which patient characteristics affected their treatment choice. Main outcomes The primary outcome was the surgeons’ percentage correct predictions. We also compared this percentage between experienced knee surgeons and other orthopaedic surgeons, and between treatment responders and non-responders. Results We received 194 (17%) complete responses for all 20 patient profiles, resulting in 3880 predictions. Overall, 50.0% (95% CI 39.6% to 60.4%) of the predictions were correct, which equals the proportion expected by chance. Experienced knee surgeons were not better in predicting outcome than other orthopaedic surgeons (50.4% vs 49.5%, respectively; p=0.29). The percentage correct predictions was lower for patient profiles of non-responders (34%; 95% CI 21.3% to 46.6%) compared with responders (66.0%; 95% CI 57.0% to 75.0%; p=0.01). In general, bucket handle tears, knee locking and failed non-operative treatment directed the surgeons’ choice towards APM, while higher level of osteoarthritis, degenerative aetiology and the absence of locking complaints directed the surgeons’ choice towards exercise therapy. Conclusions Surgeons’ criteria for deciding that surgery was indicated did not pass statistical examination. This was true regardless of a surgeon’s experience. These results suggest that non-surgical management is appropriate as first-line therapy in middle-aged patients with symptomatic non-obstructive meniscal tears. Clinical trial registration ClinicalTrials.gov Identifier: NCT03462134.

中文翻译：

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当患者出现退行性半月板撕裂时，即使是经验丰富的整形外科医生也能预测谁将从手术中受益吗？对做出 3880 个预测的 194 名骨科医生的调查

目的 检验外科医生预测半月板半月板部分关节镜下切除术 (APM) 和运动疗法治疗中年患者半月板​​撕裂效果的能力。设计和设置电子测量。向整形外科医生调查参与者展示了 20 位患者资料。这些概况来自一项随机临床试验，比较 APM 与运动疗法治疗有症状的非阻塞性半月板撕裂的中年患者。从每个治疗组（APM 和运动治疗）中，我们选择了治疗后膝关节功能最好的 5 名患者（反应者）和最差（无反应者）的 5 名患者。荷兰和澳大利亚的1111名骨科医生和住院医师受邀参加了调查。干预 对于 20 个患者档案中的每一个，外科医生（不知道治疗分配）不得不在 APM 和运动疗法之间进行选择作为首选治疗，随后必须在 5 点李克特量表上估计两种治疗的膝关节功能的预期变化。最后，外科医生被问及哪些患者特征影响了他们的治疗选择。主要结果 主要结果是外科医生的正确预测百分比。我们还比较了经验丰富的膝外科医生和其他骨科医生之间以及治疗反应者和非反应者之间的这一百分比。结果 我们收到了所有 20 个患者档案的 194 个（17%）完整响应，产生了 3880 个预测。总体而言，50.0%（95% CI 39.6% 至 60.4%）的预测是正确的，这等于偶然预期的比例。经验丰富的膝外科医生在预测结果方面并不比其他整形外科医生更好（分别为 50.4% 和 49.5%；p=0.29）。与有反应者（66.0%；95% CI 57.0% 到 75.0%；p=0.01）相比，无反应者的患者概况（34%；95% CI 21.3% 到 46.6%）的正确预测百分比较低。一般来说，斗柄撕裂、膝关节锁定和失败的非手术治疗引导外科医生选择 APM，而更高水平的骨关节炎、退行性病因和没有锁定投诉引导外科医生选择运动疗法。结论外科医生决定手术指征的标准没有通过统计检查。无论外科医生的经验如何，这都是正确的。这些结果表明，非手术治疗适合作为有症状的非阻塞性半月板撕裂的中年患者的一线治疗。临床试验注册 ClinicalTrials.gov 标识符：NCT03462134。