This study was just published in the Arthroscopy:
Little agreement between preoperative Kellgren and Lawrence classification and intraoperative Outerbridge score in patients undergoing arthroscopic partial meniscectomy
And, well, the title says it all. Their study included over 400 middle-aged (average 49 years) obese patients (average BMI 30.2).
Authors wrote:
Understanding the degree of cartilage degeneration prior to a knee arthroscopy procedure is important for surgical planning and postoperative prognosis.
That might be true if you’re planning a total knee replacement, but what is its relevance in meniscectomy? The authors do not cite any trials demonstrating that, on average, meniscectomy is a useless operation. That’s understandable—meniscectomy seems to be their essential tool to “treat” knee pain.
Furthermore, they operate primarily on obese, middle-aged patients—essentially, the group most likely to have degenerative knee disease. Even if you perform a meniscectomy, the patient remains middle-aged and obese post-op. I just don’t understand the rationale for using meniscectomy in this population. The pain-generating factor is anything but a degenerative meniscus tear.
Authors conclude:
…the association between radiographic assessments and cartilage health may need to be reconsidered due to this lack of correlation
And then what follows? You don’t need to rethink radiographic assessment—you need to acknowledge that meniscectomy is a mostly useless operation, and that knee pain in middle-aged, obese patients is due to something else.
I´ll just leave this here (from our study):
