Arthroscopic meniscal surgery in Norway from 2010 to 2020: A paradigmatic shift

Abstract

Purpose

Meniscal injuries in the knee are usually treated surgically with arthroscopic partial resection (APR) or arthroscopic repair (AR). APR has been shown to increase the risk of osteoarthritis and the focus has shifted to repairing the meniscus with AR. The extent of this shift is yet to be established and an analysis of incidence rates (IR) of APR and AR for meniscal injuries could highlight this.

Methods

Data from the Norwegian Patient Registry (NPR) and Statistics Norway (SN) from 2010 to 2020 were collected. The number of procedures, demographics and facilities providing meniscal surgery were obtained from NPR, while population size and catchment area were collected from SN. IR of APR and AR and APR/AR rate ratios were estimated and compared.

Results

A total of 119,528 knee arthroscopies were performed, 89.6% of which were APR. The number of APR performed nationally decreased by 72%, while AR procedures increased by 178%. The national IR of APR decreased from 298 to 82/100,000 inhabitants (p < 0.001). For AR, the national IR increased annually from 13/100,000 inhabitants to a peak in 2019 of 32/100,000 inhabitants (p < 0.001). The APR/AR rate ratio decreased from 22 to below five and the APR/AR trend curves showed a statistically significant decrease (p < 0.001).

Conclusion

Surgical treatment of meniscal injuries has changed, with a substantial reduction in APR and a strong increase in AR. The reduction in APR, especially in older patients, suggests that meniscal surgery in Norway has undergone a paradigmatic shift, in line with recent literature.

Level of Evidence

Level IV.