Tag: knee injury

Categories : Surgeries & ProceduresTags :

One of the World’s Most Common Knee Surgeries not Helpful – May Even Be Harmful

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Partial meniscectomy does not improve patient symptoms or function, reveals a 10-year follow-up of the FIDELITY, a placebo-surgery controlled trial

Photo by Towfiqu barbhuiya

Trimming a degenerated meniscus, or partial meniscectomy, is one the most common orthopaedic surgeries in the world. Even though the number of procedures in Finland has decreased significantly in recent years, the surgery continues to be performed widely internationally.

A 10-year follow-up study has revealed that, compared to sham surgery, partial meniscectomy did not improve patients’ symptoms or function. On the contrary, the 10-year follow-up of patients who had undergone partial meniscectomy found them to have more symptoms, more reduced function, increased progression of osteoarthritis and a higher probability of subsequent knee surgery when compared to sham surgery. 

The Finnish Degenerative Meniscal Lesion Study (FIDELITY) study is unique both with regard to its research design, ie, the sham surgery control group, and its 10-year patient follow-up. In the study, patients with degenerative meniscal tears were randomised to undergo a partial meniscectomy or sham surgery.

Teppo Järvinen, Professor at the University of Helsinki and the principal investigator of the FIDELITY emphasises the broader significance of the results: “Our findings suggest that this may be an example of what is known as a medical reversal, where broadly used therapy proves ineffective or even harmful.”

“The surgery is based on the assumption that pain in the inside of the knee is caused by a medial meniscus tear, which can be treated surgically. Such reasoning – assumption based on biological credibility – is still very common in medicine but in this case, the assumption does not withstand critical examination. Based on current understanding, pain in various joints, such as the knee joint in this case, is related to degeneration brought about by aging,” says Raine Sihvonen, Specialist in Orthopaedics and Traumatology and the other principal investigator of the FIDELITY study. 

Concerns about the adverse effects of surgery

The registry and other observational data published in recent years have elicited concern about the potential harm caused by partial meniscectomy.  Based on this data, the risk of arthroplasty, or joint replacement surgery, as well as a potentially higher risk of complications following the surgery has been associated with partial meniscectomy. However, the evidence provided by observational studies is inherently indirect and cannot be used to demonstrate a causal effect.

“Several randomised studies have already demonstrated that partial meniscectomy has not improved patients’ symptoms or function in the short (1–2 years) or medium (5 years) term. Regardless, the procedure has remained widely used in many countries,” says Doctoral Researcher and Specialist in Orthopaedics and Traumatology, Dr Roope Kalske.

“For nearly a decade, many independent, non-orthopaedic organisations providing clinical guidelines have recommended that the procedure should be discontinued. Still, for example, the American Academy of Orthopaedic Surgeons (AAOS) and the British Association for Surgery of the Knee (BASK) have continued to endorse the surgery.

This effectively illustrates how difficult it is to give up inefficient therapies,” Järvinen sums up.

“The study conducted in five hospitals is an example of smooth multicentre collaboration, as well as the commitment of research patients to an interesting project. Of the original 146 participants, more than 90% took part in the final stage of the study,” says the research manager Pirjo Toivonen. 

Source: University of Helsinki

Categories : Injury & Trauma Surgeries & ProceduresTags :

Engineered Cartilage from Nasal Septum Cells helps Treat Complex Knee Injuries

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Researchers grow cartilage replacements from cells of the nasal septum to repair cartilage injuries in the knee. (Photo: University of Basel, Christian Flierl)

An unlucky fall while skiing or playing football can spell the end of sports activities. Damage to articular cartilage does not heal by itself and increases the risk of osteoarthritis. Researchers at the University of Basel and the University Hospital Basel have now shown that even complex cartilage injuries can be repaired with replacement cartilage engineered from cells taken from the nasal septum.

A team at the Department of Biomedicine led by Professor Ivan Martin, Dr Marcus Mumme and Professor Andrea Barbero has been developing this method for several years. It involves extracting the cells from a tiny piece of the patient’s nasal septum cartilage and then allowing them to multiply in the laboratory on a scaffold made of soft fibres. Finally, the newly grown cartilage is cut into the required shape and implanted into the knee joint.

Earlier studies have already shown promising results. “Nasal septum cartilage cells have particular characteristics that are ideally suited to cartilage regeneration,” explains Professor Martin. For example, it has emerged that these cells can counteract inflammation in the joints.

More mature cartilage shows better results

In a clinical trial involving 98 participants at clinics in four countries, the researchers compared two experimental approaches. One group received cartilage grafts that had matured in the lab for only two days before implantation – similar to other cartilage replacement products. For the other group, the grafts were allowed to mature for two weeks. During this time, the tissue acquires characteristics similar to native cartilage.

For 24 months after the procedure, the participants self-assessed their well-being and the functionality of the treated knee through questionnaires. The results, published in the scientific journal Science Translational Medicine, showed a clear improvement in both groups. However, patients who received more mature engineered cartilage continued to improve even in the second year following the procedure, overtaking the group with less mature cartilage grafts.

Magnetic resonance imaging (MRI) further revealed that the more mature cartilage grafts resulted in better tissue composition at the site of the implant, and even of the neighbouring cartilage. “The longer period of prior maturation is worthwhile,” emphasizes Anke Wixmerten, co-lead author of the study. The additional maturation time of the implant, she points out, only requires a slight increase in effort and manufacturing costs, and gives much better results.

Particularly suited to larger and more complex cartilage injuries

“It is noteworthy that patients with larger injuries benefit from cartilage grafts with longer prior maturation periods,” says Professor Barbero. This also applies, he says, to cases in which previous cartilage treatments with other techniques have been unsuccessful.

“Our study did not include a direct comparison with current treatments,” admits Professor Martin. “However, if we look at the results from standard questionnaires, patients treated with our approach achieved far higher long-term scores in joint functionality and quality of life.”

Based on these and earlier findings, the researchers now plan to test this method for treating osteoarthritis – an inflammatory disease that causes joint cartilage degeneration, resulting in chronic pain and disability.

Two large-scale clinical studies, funded by the Swiss National Science Foundation and the EU research framework programme Horizon Europe, are about to begin. These studies will explore the technique’s effectiveness in treating a specific form of osteoarthritis affecting the kneecaps (ie, patellofemoral osteoarthritis). The activities will further develop in Basel the field of cellular therapies, strategically defined as a priority area for research and innovation at the University of Basel and University Hospital Basel.

Source: University of Basel