Scientific publications

Inappropriate use of arthroscopic meniscal surgery in degenerative knee disease (Peer Review)


Autoren: Leander L S Muheim, Oliver Senn, Mathias Früh, Oliver Reich, Thomas Rosemann & Stefan M Neuner-Jehle
Zeitschrift: Acta Orthopaedica


Background: Current evidence suggests that arthroscopic knee surgery has no 20 added benefit compared to non-surgical management in degenerative meniscal 21 disease. Yet in many countries, arthroscopic partial meniscectomy (APM) remains 22 among the most frequently performed surgeries. The aim of this study was to quantify 23 and characterize the dynamics of the current use of knee arthroscopies in 24 Switzerland in a distinctively non-traumatic patient group. 25

Methods: We assessed a non-accident insurance plan of a major Swiss health 26 insurance company for surgery rates of APM, arthroscopic debridement and lavage 27 in patients over the age of 40, comparing the years 2012 and 2015. Claims were 28 analyzed for prevalence of osteoarthritis, related interventions and the association of 29 surgery with insurance status. 30

Results: In total, 648,708 and 647,808 people were examined in 2012 and 2015, 31 respectively. The incidence of APM, debridement and lavage was 388 per 105 32 person-years in 2012 and 352 per 105 person-years in 2015 in non-traumatic patients 33 over the age of 40, consisting mostly of APM (95.6%). There was no statistically 34 significant change in surgery rates between 2012 and 2015 among patients aged 40-35 64. Overall prevalence of osteoarthritis was 25%. Insurance status was 36 independently associated with arthroscopic knee surgery. 37

Interpretation: APM is widely-used in non-traumatic patients in Switzerland, which 38 contrasts to current evidence. Many procedures take place in patients with 39 degenerative knee disease. Surgery rates did not change in non-traumatic middle-40 aged patients between 2012 and 2015. Accordingly, the potential of inappropriate 41 use of APM in non-traumatic patients in Switzerland is high.

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