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Arthroscopic Knee Surgery Can’t Outshine Sham Procedure In FIDELITY Trial

This article was originally published in The Gray Sheet

Executive Summary

Patients randomized to a sham procedure enjoy similar outcomes as those undergoing arthroscopic partial meniscectomy surgery in the FIDELITY trial, the latest study to find no clear benefits from a common arthroscopic knee surgery procedure.

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No to knee 'scoping: Arthroscopic knee surgery for osteoarthritis provides no additional benefits to optimized physical and medical therapy alone, according to the results of a Canadian study appearing in the Sept. 11 issue of the New England Journal of Medicine. Researchers at the University of Western Ontario randomized 178 patients with moderate-to-severe osteoarthritis of the knee to either surgical lavage and arthroscopic debridement plus physical and medical therapy or physical and medical therapy alone. After two years, the mean scores for both groups on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index were almost the same: 874 for the surgery group and 897 for the control group. Analysis of the WOMAC scores and other secondary endpoints also showed no superiority for surgery. The results of this study on top of several previous studies on arthroscopic knee lavage and debridement "call into question the widespread use of arthroscopic treatment for osteoarthritis of the knee," Alexandra Kirkley et al. write. They also observe that "although some may argue that treatment is beneficial for patients with mechanical symptoms of catching or locking or those with early disease, prespecified subgroup analyses also failed to show efficacy in this population of patients.

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