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Consistent with studies in the general population, "Arthroscopic meniscectomies increase the risk of TKA for WC claimants," according to the new research by Nicholas F. Tsourmas, MD of Texas Mutual, Workers’ Compensation Insurance, Austin, Texas and Johns Hopkins School of Medicine, Baltimore, and colleagues. They analyzed national WC insurance data on 17,247 lost-time claims involving any type of arthroscopic knee surgery.
Overall, 37.0% of patients underwent arthroscopic meniscectomy (AM): a minimally invasive surgical procedure to treat tears of the meniscus cartilage in the knee. Over 10 years' follow-up, 2.4% of workers had TKA. The TKA rate was higher in older age groups: 0.4% in claimants under 40 years old versus 4.0% in those over age 60.
Workers with prior AM were more likely to undergo TKA. After controlling for sex, age, and attorney involvement, the odds ratio for TKA was 2.20 for claimants with prior AM.
The relative increase in TKA associated with prior AM was markedly higher for younger patients: odds ratio 7.22 for those younger than 40 years versus 1.46 for those over age 60. Younger workers also had a longer time between AM and TKA: average 2.60 versus 1.04 years.
Over the past two decades, studies have questioned the benefits of AM in patients with knee pain. In contrast to studies reporting decreased use of AM in the general population, the new analysis shows no little or no change in the rate of AM among WC cases. "This would seem to indicate that changes in the medical practice of physicians treating workers covered by WC do not reflect changes occurring in medical practice in most non-WC populations covered by other forms of insurance," the researchers write.
The authors discuss the implications for management of knee-related WC claims, emphasizing the "paramount importance" of preserving the preserving the integrity of meniscal cartilage in most cases. Dr. Tsourmas and colleagues conclude: "There appears to be greater urgency among physicians treating WC claimants to adopt this message, as our study indicates there has not been a material change in the frequency of AM since the publication of studies questioning the benefits of AM for patients with symptomatic knee pain."