The FIDELITY trial is a multicenter, double-blind, sham-controlled RCT in 146 patients aged 35 to 65 with a degenerative medial meniscus tear and no osteoarthritis. It asks whether arthroscopic partial meniscectomy actually outperforms a placebo surgical procedure. Patients were randomized to true meniscectomy or a fully simulated sham arthroscopy, then followed for 12 months.
When a 50-year-old presents with medial joint-line pain and an MRI showing a degenerative medial meniscus tear but no arthritis, this trial says the torn fragment is probably not the pain generator worth operating on.
FIDELITY is the strongest design possible for this question: a true sham control with allocation concealed from patients and outcome assessors. That matters because surgery carries a powerful placebo effect, and meniscal symptoms are subjective.
Both groups improved by roughly 20 to 25 points on validated scores, so patients do get better, just not because of the resection. This reflects natural history plus placebo.
The key mental model: a degenerative tear is often an early marker of osteoarthritis, not a discrete mechanical lesion. Pair this with the Katz 2013 trial (meniscectomy plus PT no better than PT for tears with OA) and the message is consistent. First-line management is structured physical therapy and time, reserving arthroscopy for true mechanical locking or traumatic tears.
The FIDELITY trial is a multicenter, double-blind, sham-controlled RCT in 146 patients aged 35 to 65 with a degenerative medial meniscus tear and no osteoarthritis. It asks whether arthroscopic partial meniscectomy actually outperforms a placebo surgical procedure. Patients were randomized to true meniscectomy or a fully simulated sham arthroscopy, then followed for 12 months.
When a 50-year-old presents with medial joint-line pain and an MRI showing a degenerative medial meniscus tear but no arthritis, this trial says the torn fragment is probably not the pain generator worth operating on.
FIDELITY is the strongest design possible for this question: a true sham control with allocation concealed from patients and outcome assessors. That matters because surgery carries a powerful placebo effect, and meniscal symptoms are subjective.
Both groups improved by roughly 20 to 25 points on validated scores, so patients do get better, just not because of the resection. This reflects natural history plus placebo.
The key mental model: a degenerative tear is often an early marker of osteoarthritis, not a discrete mechanical lesion. Pair this with the Katz 2013 trial (meniscectomy plus PT no better than PT for tears with OA) and the message is consistent. First-line management is structured physical therapy and time, reserving arthroscopy for true mechanical locking or traumatic tears.