Do orthopaedic surgeons agree on the willingness-to-randomize young patients with meniscal tears for repair versus resection? A video review study.

Objective: A randomized controlled trial (RCT) comparing meniscal repair versus resection is highly needed but may be difficult to perform due to strong surgeon treatment preferences. Therefore, we performed a pilot study to explore orthopaedic surgeons' willingness-to-randomize meniscal tear patients to inform a future multicentre RCT. Method: Orthopaedic surgeons in The Netherlands (n = 26) and Sweden (n = 1) reviewed 19 arthroscopic video recordings of 19-46-year-old patients with isolated meniscal tears undergoing arthroscopic surgery (meniscal repair/resection). The orthopaedic surgeons reviewed the initial arthroscopic visualization of the knee joint and judged 1) whether they were willing-to-randomize the meniscal tear (yes/no), 2) which meniscal surgery they would perform on the tear (resection, repair, or no surgery), and 3) whether they preferred non-surgical treatment over surgical treatment (yes/no). We used Fleiss kappa with 95% confidence intervals (CI) to estimate agreement. Results: Twenty-seven knee surgeons with a median [range] of 12 [1-32] years of experience reviewed the videos. The Fleiss Kappa for agreement on whether to randomize a meniscal tear was 0.14 (95% CI 0.03-0.26). Agreement was 0.38 (95% CI 0.25-0.51) for the choice of meniscal surgery and 0.29 (95% CI 0.12-0.45) for preferred treatment option. Conclusion: Orthopaedic surgeons seem to exhibit little agreement as to whether they are willing to randomize a patient with an isolated meniscal tear, but also what treatment option they prefer. Our results suggest 1) an RCT for comparing resection vs repair is needed, and 2) alongside this RCT an observational experiment should evaluate if non-consensus results in pseudo-randomization.