Patients with meniscus lesions benefit from a combination of sham surgery and physiotherapy just as much as from a real surgical procedure-- this was the conclusion reached in the Finnish FIDELITY study published in 2013. Ever since then, there has been considerable discussion about the benefits of meniscus surgery compared with physiotherapy. After all, about 300,000 meniscus procedures were performed in Germany in 2013. The question is: Should the non-surgical approach be preferred over surgical treatment or are there still advantages offered by surgery. To find out, Wolf Petersen, Andrea Achtnich and co-authors reviewed the current literature on the treatment of meniscus lesions and evaluated the advantages and disadvantages of each approach in their original article published in Deutsches Ärzteblatt International (Dtsch Arztebl Int 2015; 112: 705-13).
The Berlin-based orthopedic surgeons analyzed six randomized studies to establish which management approach--surgical or physiotherapy-- provides the greatest benefits to patients with meniscus tears. Almost all of these studies demonstrated comparable outcomes for the two treatment options. However, in about half of the studies there were some patients who did not respond to physiotherapy. These were then switched to the surgical study arms. After surgery, the outcomes achieved in these patients were comparable to those of the other patients who underwent surgery. Based on the data of these studies, the authors arrived at the conclusion that patients with a flap tear may not benefit from physiotherapy but may do so from arthroscopic partial meniscectomy. For this group of patients, surgery may be the treatment option to be recommended. However, targeted studies would need to be performed in the future to support such recommendation.