What was left out from our critical APM paper?

Early this year, we published a paper that I am incredibly proud of. For a long time, I have thought that arthroscopic partial meniscectomy in the treatment of degenerative meniscus tears “does not make sense.” I mean that there is no credible biological mechanism for removing the torn meniscus to make the knee any better in terms of pain and function. After a long hard work, our paper titled Arthroscopic partial meniscectomy: did it ever work? – A narrative review from basic research to proposed disease framework and science of clinical practice was published in the Acta Orthopaedica. What makes me even more, happier is the fact that our paper remains to be the most read article in the Acta.

https://actaorthop.org/ at August 7th 2022

A few essential references were left out of the paper. One very important study, which I would now add, was this one by van de Graaf et al.: Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions.

We concluded in our paper:

Until a subpopulation that benefits from APM is identified, it has no role in the treatment of degenerative meniscal tears.

A widespread claim to contradict the result of high-quality RCTs is that it is all about selecting the “right patients” for the procedure. After 50 years of daily practice, it remains scientifically unproven how to identify those patients who respond to the treatment. In this sense, the study by van de Graaf is gold. They showed in their study that even experienced surgeons could not robustly “identify” those patients who benefit from APM. Source data in this study was from their ESCAPE RCT, in which APM was compared to nonoperative treatment.

Everything still points in the same direction: degenerative meniscus tear is not to be treated with APM, there is no credible disease, and “optimal patient selection” is a myth waiting to be proven.

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