Knee arthroscopy: evidence for a targeted approach.

Like many areas of medicine, the role of arthroscopy is evolving and its use must be guided by critical analysis of the scientific evidence. Data evaluating arthroscopic knee surgery is complex with heterogenous pathology, patient populations and techniques and, therefore, must be interpreted with care. Attention-grabbing headlines and animations can stimulate discussion, but when key aspects of published science are overlooked, they risk oversimplification. We believe a number of articles published in a recent edition of the British Journal of Sports Medicine (BJSM) represent examples where science may be overshadowed by oversimplification. Thus, we offer additional insights to focus the place of arthroscopy in the management of joint problems. To our interpretation, recent BJSM publications appear to take an emotional stance, indicating that all arthroscopy for conditions that cause joint pain is bad and should be stopped.1 2 Following an article reporting a decline in the rate of arthroscopy in Finland,3 Ardern et al provided a provocative editorial citing reasons for this change as reduced reimbursement, medical overuse and grass roots pressure.1 Scientific evidence was not one of the five reasons given directly. An editorial by Engebretsen and Moatshe4 in the same edition provides a more balanced discussion on the 5-year results of the Finnish Degenerative Meniscus Lesion Study (FIDELITY) trial also published in the same issue.5 This editorial contends that the conclusion by Sihvonen and colleagues that arthroscopic partial meniscectomy is associated with a greater risk of osteoarthritis is too strong for the data presented.4 They also point out that patients with …