Arthroscopic partial meniscectomy for degenerative meniscal tear.

To the Editor: Previous studies have suggested that partial meniscectomy has little benefit in patients with advanced osteoarthritis1,2 but some benefit in those with mild-to-moderate osteoarthritis.3 Sihvonen and colleagues (Dec. 26 issue)4 attempted to assess the benefit of partial meniscectomy in patients without osteoarthritis. However, although the authors excluded patients with radiographic degenerative changes, the declaration of “no knee osteoarthritis” is misleading. It is important to note that patients in this study did have cartilage degeneration. In fact, 80% of the patients in the partial-meniscectomy group and 67% of those in the sham group had degenerative or osteoarthritic changes on diagnostic arthroscopy. In addition, patients with traumatic tears or mechanical symptoms were excluded, yet this is probably the group that would benefit most from arthroscopic partial meniscectomy.5 Lastly, magnetic resonance imaging (MRI) was not used to exclude or stratify patients according to factors such as subchondral edema or chondromalacia. We submit that arthroscopy remains an effective treatment for meniscal tears in selected patients. Surgical decision making should be individualized, including consideration of mechanical symptoms, degenerative versus traumatic meniscal tear, and other pain generators, including the degree of arthritis.