This is a tweetorial about arthroscopic partial meniscectomy I posted on Twitter.
Arthroscopic partial meniscectomy remains to be a hot topic in orthopaedics. This is a narrative #tweetorial about the most common orthopedic procedure to date. #apm #knee #arthoscopy #orthopedics #rct @TeemuVKarjalain @orthopaedics12
— Aleksi Reito (@AleksiReito) June 10, 2019
Much more common is a degenerative meniscal tear (DMT) which is not usually associated to any injury. It is basically an early stage of osteoarthritis.
— Aleksi Reito (@AleksiReito) June 10, 2019
Once deemed as very difficult to learn, APM has become mainstream in modern day practice… https://t.co/bo7KZQTdXH pic.twitter.com/Z9LlQ9ve8a
— Aleksi Reito (@AleksiReito) June 10, 2019
— Aleksi Reito (@AleksiReito) June 10, 2019
— Aleksi Reito (@AleksiReito) June 10, 2019
Patients had both quick recovery and excellent results after APM. https://t.co/bTi5Yq4Wvc pic.twitter.com/wrFXNpmvxQ
— Aleksi Reito (@AleksiReito) June 10, 2019
And in patients aged 50 or more… https://t.co/Fi9Jc65GOY pic.twitter.com/lLZMLMNSWi
— Aleksi Reito (@AleksiReito) June 10, 2019
— Aleksi Reito (@AleksiReito) June 10, 2019
*All these studies lacked any control group. *
— Aleksi Reito (@AleksiReito) June 10, 2019
First RCT comparing APM and placebo was published in 2002. https://t.co/ernGsmNpaW pic.twitter.com/Cjbcuj9gy9
Most recent meta-analysis based on this evidence concludes:
— Aleksi Reito (@AleksiReito) June 10, 2019
“Performing APM in all patients with knee pain and a meniscal tear is not appropriate, and surgical treatment should not be considered the first-line intervention.” https://t.co/pDIHZzMkR3
There are recent recommendations from @baskonline (https://t.co/3xoeIvhFcV ) and @ISAKOS (https://t.co/EuhG7O6aux ).
— Aleksi Reito (@AleksiReito) June 10, 2019
The latter supports the use of APM if "symptoms proved refractory to non-op management" pic.twitter.com/KsKvxdIq8i
Finally, how has the orthopaedic community responded to this bulk of evidence? Not as would be expected. Further studies are urgently warranted to investigate more recent trends in meniscectomy surgeries. pic.twitter.com/ISXc7JwCHn
— Aleksi Reito (@AleksiReito) June 10, 2019
"We propose that the annual proportion of knee arthroscopy
— Aleksi Reito (@AleksiReito) June 10, 2019
procedures that areAPM-only inpatientswithdegenerative disease
is a surgeon-level measure of appropriateness in surgical
care."https://t.co/5S4RG5Ct2a pic.twitter.com/pKoXC1qcBJ