05 May NEJM: Arthroscopic Partial Meniscectomy Provided No Benefit Over Placebo Surgery and May Worsen Longterm Outcomes

Dr. Järvinen

MedicalResearch.com Interview with:
Teppo Järvinen MD PhD
Professor of Orthopaedics and Traumatology
University of Helsinki, HUS

MedicalResearch.com: What is the background for this study?

Response: Arthroscopic partial meniscectomy (APM) is one of the most frequently performed orthopedic procedures worldwide, particularly for middle-aged and older patients with knee pain and a degenerative meniscal tear.

Over the past 15–20 years, multiple randomized trials have questioned the effectiveness of this procedure, showing no meaningful benefit compared with non-operative care (typically, exercise or physical therapy) or even placebo (sham) surgery in the short to medium term.

Our study reports the 10-year follow-up of the FIDELITY trial, a randomized, placebo-surgery controlled trial.

MedicalResearch.com: What are the main findings?

Response:  The main findings are straightforward: APM provided no benefit over placebo surgery for symptoms or function. Moreover, we observed a consistent pattern suggesting worse long-term outcomes in the surgery group, including more symptoms, reduced function, greater progression of osteoarthritis, and a higher likelihood of subsequent knee surgery.

MedicalResearch.com:  Do you think if meniscectomy is performed at a younger age, perhaps closer to when trauma occurs, chronic or progressive pain would be less likely to develop?

Response:  Our study specifically addresses middle-aged and older patients with degenerative meniscal tears, so strictly speaking it does not directly answer this question.

However, the commonly suggested distinction — that surgery may not work for degenerative tears but could still benefit “traumatic” or acute-onset tears — is increasingly difficult to support.

We now have several high-quality studies addressing this question more directly, including a large comparative cohort study (Thorlund et al., BMJ 2017) and two randomized trials (Skou et al., NEJM Evidence; van der Graaff et al., BJSM). Across these studies, arthroscopic partial meniscectomy has not shown meaningful benefit over structured exercise therapy, even in patients young individuals with more acute/traumatic symptom onset.

So the idea that “timing” or labeling a tear as traumatic fundamentally changes the effectiveness of the procedure is not well supported by the available evidence.

On the contrary, there is a large body of observational evidence linking the procedure (APM) to an increased risk of osteoarthritis progression. Our trial adds randomized, placebo-controlled evidence suggesting that the procedure itself may contribute to worse long-term outcomes.

MedicalResearch.com: What should readers take away from your report?

Response: There are two key messages.

First, arthroscopic partial meniscectomy does not provide meaningful benefit for patients with knee pain attributed to a degenerative meniscal tear.

Second, the procedure may not be harmless. There has long been observational evidence suggesting worse long-term outcomes after APM, including a higher likelihood of subsequent total knee replacement (TKR) and poorer outcomes after TKR. Our findings provide randomized evidence consistent with that signal of harm.

More broadly, widely used procedures are not necessarily effective simply because they are commonly performed. They need to be tested rigorously.

MedicalResearch.com: What recommendations do you have for future research as a results of this study?

Response: Future research should move beyond refining surgical techniques for meniscal tears (whether ‘degenerative’ or ‘acute and/or traumatic’) and instead focus on understanding the underlying causes of knee pain in this population.

There is growing evidence that meniscal tears are often incidental findings and not the primary driver of symptoms.

If new surgical approaches are proposed, they should be evaluated in well-designed randomized trials, ideally including placebo controls.

MedicalResearch.com: Is there anything else you would like to add?

Response: This study contributes to the concept of medical reversal, where widely used treatments are shown to be ineffective or harmful when tested rigorously.

Disclosures: The author reports no relevant financial conflicts of interest. The study was supported by non-commercial funding from governmental agencies and research foundations.

Citation: Kalske R, Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Kalske J, NurmiH, Toivonen P, Sillanpää N, Kiekara T, Turkiewicz A, Englund M, Taimela S, JärvinenTLN; FIDELITY Investigators. Arthroscopic Partial Meniscectomy for Degenerative Tear- 10-Year Outcomes. N Engl J Med. 2026 Apr 30;394(17):1757-1759. doi:10.1056/NEJMc2516079. PMID: 42054686
https://www.nejm.org/doi/full/10.1056/NEJMc2516079

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition.Some links are sponsored. Products, services and providers are not warranted or endorsed. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Last Updated on May 5, 2026 by Marie Benz MD FAAD