The procedure, known as arthroscopic partial meniscectomy, treats meniscus tear, a common problem that causing symptoms like locking, catching, and persistent pain. It involves trimming and removing damaged meniscal tissue.
Radiographic osteoarthritis progressed in 81 percent of the meniscectomy group, compared with 70 percent of the placebo group. In addition, 12 percent of patients who underwent meniscectomy later received a knee replacement or high tibial osteotomy—a surgery that realigns the knee—compared with 4 percent of the placebo group.
“For the vast majority of these patients, the procedure provides no meaningful long-term benefit and should no longer be routinely performed,” Teppo Järvinen, professor at the University of Helsinki and the study’s principal investigator, told The Epoch Times.
A Surgery Built on Untested Assumptions
The meniscus is a crescent-shaped piece of cartilage that acts as a shock absorber between the thigh and shin bones. A torn meniscus is one of the most common knee injuries, and partial meniscectomy, which trims away the damaged portions, has become one of the world’s most frequently performed orthopedic surgeries.
The rationale originally came from younger patients with traumatic injuries, where symptoms were clearly linked to the tear itself. As MRI became more widely used, similar-looking tears were increasingly detected in middle-aged and older adults with knee pain.
“The assumption was that these MRI-detected tears were the cause of symptoms and therefore should be surgically treated,” Järvinen said.
The assumption, it turns out, was never rigorously tested before the procedure became standard practice. “This is a classic example of what might be called a ‘bioplausibility trap,’” Järvinen added. “The treatment sounds intuitively logical, so it becomes widely adopted before being rigorously tested.”
Why Surgery May Make Things Worse
The findings may partly reflect what the meniscus actually does. Removing parts of the meniscus may reduce the knee’s natural shock absorption and load distribution, potentially accelerating osteoarthritis progression and the need for later knee replacement surgery.
In many middle-aged and older adults, a meniscal tear is not an isolated injury but part of the broader aging process of the knee. “Removing meniscal tissue from an already degenerating knee may simply accelerate that process [osteoarthritis],” Järvinen said.
Interestingly, many patients of the study improved over time, whether they took the real or placebo surgery, suggesting that recovery may often reflect the natural course of the condition rather than the removal of meniscal tissue, Järvinen said.
“Most of these patients fare well with no intervention to the meniscus—in other words, the symptoms resolve on their own,” he said.
Treating Symptoms, Not the Joint
Not everyone agrees the findings should change practice.
Dr. Robert Brophy, a professor of orthopedic surgery and chief of sports medicine at the Washington University School of Medicine, said partial meniscectomy is not a first-line treatment for degenerative meniscal tears but remains a reasonable treatment option for patients who have already tried medications, physical therapy, and injections without relief.
The surgery was never meant to protect the joint long-term, Brophy told the Epoch Times. “No one expects surgery to have an impact on what happens to the knee years from now. We know that we’re not doing surgery to protect the joint. We’re doing surgery to treat symptoms.”
For patients with persistent, debilitating pain who have exhausted other options, he said, dismissing surgery entirely leaves them without recourse.
“The answer is not to go do total knees in somebody years before they need it or to make them limp around and not do anything.”
The study isn’t a “game changer,” Brophy said, but “another piece of information in what’s an evolving area,” noting that identifying which patients genuinely benefit from surgery remains an unsolved problem.
When Surgery Makes Sense
The trial’s findings should not be applied to every type of meniscal injury. It was conducted specifically on degenerative meniscal tears in middle-aged adults.
Surgery may still help with certain traumatic tears seen more often in younger people, including bucket-handle tears, where a large torn section flips into the joint and can lock the knee, and unstable flap tears, where a loose piece catches in the knee, Järvinen said.
“Bucket handle tears remain an important exception, as they often do require surgery because of true mechanical obstruction of the joint,” he said.
“In middle-aged and older adults, meniscal findings are somewhat different biologically, reflecting degeneration of the tissue rather than purely traumatic injury,” Järvinen said, adding that while bucket handle tears can still occur in this age group, “these cases are exceptions, not the rule.”
More Research Is Needed
While reliable recent data are limited and clinical practice varies across countries and healthcare systems, Järvinen noted that arthroscopic partial meniscectomy likely remains widely used, given that major orthopedic organizations in both the United States and the UK still endorse the procedure for selected middle-aged and older patients with knee pain.
Continued use of the procedure for degenerative tears in middle-aged and older adults, according to Järvinen, reflects “how difficult it can be for medicine to abandon established practices once they become deeply embedded in clinical culture.”
Medicine often changes slowly, especially when treatments appear sensible and many patients improve over time regardless of the intervention, he said.
For now, the findings add to growing evidence, while underscoring the need to better identify which patients are most likely to benefit from the procedure—and whether those benefits last.
