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One of the World’s Most Common Knee Surgeries May Offer No Benefit & Could Even Cause Harm

A major long-term study has raised serious questions about one of the most commonly performed orthopedic procedures in the world: partial meniscectomy, a surgery used to treat degenerative meniscus tears in the knee.

According to a 10-year follow-up of the FIDELITY trial, published in the New England Journal of Medicine, the procedure does not improve pain or knee function when compared to placebo (sham) surgery. Even more concerning, patients who underwent the surgery showed worse long-term outcomes, including increased knee problems and higher rates of further surgery.

These findings are prompting experts to rethink a procedure that has been performed for decades across the globe.

What is Partial Meniscectomy?

The knee contains a C-shaped piece of cartilage called the meniscus, which acts as a cushion between the thigh bone and shin bone. Over time, especially with aging, this cartilage can wear down or tear.

In a partial meniscectomy, surgeons remove the damaged part of the meniscus using arthroscopic (keyhole) surgery. It is one of the most frequently performed orthopedic surgeries worldwide, often recommended for knee pain linked to “degenerative meniscal tears.”

For years, the procedure has been based on a simple assumption:

If the torn meniscus is causing pain, removing the damaged part should reduce symptoms.

However, the latest evidence challenges this belief.

The FIDELITY Study: A Rare and Powerful Trial Design

The Finnish Degenerative Meniscal Lesion Study (FIDELITY) is considered unique in medical research because it used a placebo surgery (sham surgery) control group.

In the study:

  • Patients with degenerative meniscus tears were randomly assigned to either:

    • real partial meniscectomy, or

    • sham surgery (where no actual repair was done)

  • Neither patients nor evaluating doctors initially knew who received which treatment

This type of study is extremely rare in surgery, but it is considered the most reliable way to test whether a procedure truly works beyond psychological or placebo effects.

Researchers followed patients for 10 years, making it one of the longest and most detailed surgical outcome studies ever conducted in this field.

Key Findings: No Benefit from Surgery

The results were striking.

Compared to patients who had sham surgery, those who underwent partial meniscectomy:

  • Did not experience better pain relief

  • Did not show improved knee function

  • Reported more knee symptoms over time

  • Showed faster progression of osteoarthritis

  • Had a higher likelihood of needing further knee surgery

In simple terms, removing part of the meniscus did not help patients recover better—and may have actually worsened long-term outcomes.

Even More Concerning: Possible Long-Term Harm

The study suggests that partial meniscectomy may not just be ineffective, but potentially harmful in the long run.

Patients who had the surgery showed:

  • Increased signs of osteoarthritis progression

  • Higher risk of needing knee replacement surgery (arthroplasty)

  • More persistent knee pain and functional limitations

Osteoarthritis is a degenerative joint condition where cartilage slowly breaks down, leading to stiffness, swelling, and pain. The findings suggest that removing part of the meniscus may accelerate this process in some patients.

Experts Call It a “Medical Reversal”

Professor Teppo Järvinen from the University of Helsinki, one of the lead investigators, described the findings as a possible case of “medical reversal.”

This term is used when a widely accepted medical treatment is later proven ineffective—or even harmful—through strong scientific evidence.

He explained that the procedure is based on a long-standing belief: that knee pain comes directly from meniscus tears and can be fixed by removing damaged tissue. However, modern understanding shows that knee pain is often linked more broadly to age-related joint degeneration, not just isolated tears.

In many cases, the tear may not be the real source of pain at all.

Why This Surgery Became So Common

Partial meniscectomy became popular because:

  • It is minimally invasive (small incisions, quick recovery)

  • Early patients often reported short-term pain relief

  • Doctors believed structural damage should be “fixed”

  • Imaging like MRI often showed meniscus tears clearly

However, medical experts now warn that seeing a tear on MRI does not always mean it is the cause of pain. Many older adults have meniscus tears without any symptoms.

This has led to widespread surgeries that may not always be necessary.

Previous Studies Already Raised Doubts

The FIDELITY 10-year results are not the first warning sign.

Earlier randomized trials already showed that:

  • At 1–2 years, no major benefit was seen compared to placebo surgery

  • At 5 years, results remained similar, with no meaningful improvement

Despite this growing evidence, the surgery has continued to be performed widely in many countries.

Why Is the Surgery Still Done?

According to researchers, changing medical practice is slow—even when evidence is strong.

Doctoral researcher Dr. Roope Kalske noted that many clinical guidelines now recommend avoiding the procedure. However, some major orthopedic organizations have continued to support it.

This reflects a broader issue in medicine:

Once a treatment becomes standard practice, it can take years—even decades—to stop using it, even if it is no longer effective.

Concerns from Observational Studies

Earlier observational data had already raised concerns that partial meniscectomy might:

  • Increase risk of knee replacement later in life

  • Lead to more complications over time

However, those studies could not prove cause and effect. The FIDELITY trial now provides stronger evidence because it directly compared surgery with placebo in a randomized design.

High Patient Participation Strengthens the Study

The study was conducted across five hospitals, showing strong collaboration between research teams.

Out of the original 146 participants, more than 90% completed the 10-year follow-up, which is unusually high for long-term medical research. This makes the findings even more reliable.

Research manager Pirjo Toivonen highlighted the dedication of both patients and medical teams in completing the long study.

What This Means for Patients Today

The results suggest that many patients with degenerative meniscus tears may not need surgery at all.

Instead, experts increasingly recommend:

  • Physiotherapy and structured exercise

  • Pain management strategies

  • Weight management (when relevant)

  • Time and natural healing processes

For many people, these non-surgical approaches may provide similar or better outcomes without the risks associated with surgery.

A Shift in Modern Orthopedics

The findings from the FIDELITY trial are part of a growing shift in medicine toward evidence-based restraint, where doctors carefully evaluate whether surgery is truly necessary before recommending it.

As Professor Järvinen noted, the study highlights how important it is to question long-held assumptions in medicine—even when they seem biologically logical.

Conclusion

The 10-year FIDELITY trial delivers a powerful and surprising message:
A globally common knee surgery, partial meniscectomy, does not improve long-term outcomes and may even contribute to worsening knee health.

While surgery remains an important tool in orthopedic care, this research suggests that its use in degenerative meniscus tears should be carefully reconsidered.

For patients and doctors alike, the study serves as a reminder that in medicine, more treatment is not always better treatment—and sometimes, avoiding surgery may be the healthier choice.

Reference: Arthroscopic Partial Meniscectomy for Degenerative Tear — 10-Year Outcomes, New England Journal of Medicine (2026). DOI: 10.1056/NEJMc2516079

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