Sham surgery for meniscal knee pain – Boom! Boom! Boom! Prof Teppo Järvinen rocks the boat

BMJ talk medicine

Ahead of the Finnish Sports Physiotherapy Congress (June 9 and 10, 2017), BJSM editor in chief Karim Khan, chats with the senior author of a study that proved that partial removal of a degenerative torn meniscus does not alleviate mechanical symptoms when compared with sham surgery. That was Teppo Järvinen (http://bit.ly/2rlfW5I), professor of orthopaedics and traumatology at the University of Helsinki and a speaker at the Finnish Congress in June. Before that study (link below), orthopaedists were confident of the benefits of arthroscopic surgery on patients suffering from mechanical symptoms. However, “scientific proof of the benefits had been based entirely on uncontrolled follow-up studies,” said Dr Raine Sihvonen, specialist in orthopaedics at the Hatanpää Hospital in Tampere and first author of the study. Here is the link to the study in the New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMoa1305189#t=article In the podcast we cover: - A bird’s eye view of Bruce Moseley’s seminal sham surgery study – arthroscopy was no more helpful for knee arthroscopy in older people than sham surgery http://www.nejm.org/doi/full/10.1056/NEJMoa013259#t=article - The fact that MRI is not a good predictor of who will benefit from knee arthroscopy. Here’s Dr Martin Englund’s NEJM paper. http://www.nejm.org/doi/full/10.1056/NEJMoa0800777#t=article - Ewa Roos’ and Nina Kise’s study showing that exercise provides as good results as arthroscopic meniscectomy. Remember – the patients who fail rehab also fail surgery. Look for other solutions – not arthroscopy – to cure that patient. http://www.bmj.com/content/354/bmj.i3740 Links: Here’s a YouTube video summarizing the FIDELITY study in 4 minutes. https://www.youtube.com/watch?v=RaDWkJHmEB0 Here the link to the Finnish Sports Physiotherapy Congress – June 9 & 10, 2017. http://fspa-congress.com/