FIDELITY

Efficacy of arthroscopic partial meniscectomy (APM)

Project timeline

Study design

RCT (placebo-surgery)

Status

Follow-up & reporting

Why was this trial needed?

Meniscal damage seen in MRI is a common finding in middle-aged and older individuals with knee pain. For years, conventional wisdom held that these degenerative meniscal tears were the primary cause of symptoms, fueling the widespread use of arthroscopic partial meniscectomy (APM). However, this practice lacked solid evidence of benefit. A series of randomized controlled trials, including FIDELITY, demonstrated that APM provides minimal or no improvement in symptoms compared to placebo surgery. Concerns remain that APM may even accelerate the development of knee osteoarthritis (OA).

What is the primary objective of the FIDELITY trial?

The original FIDELITY trial showed that APM was no better than placebo surgery in relieving knee pain and other symptoms over the short term (1- and 2-year follow-ups). The extended 5- and 10-year FIDELITY-OA follow-ups aim to determine the long-term effects of APM on knee symptoms and the development and progression of knee OA.

Where are we now?

We have already published the following articles:

We have completed the final 10-year follow-ups and as of July 2025, we are finalizing the first manuscript reporting the 10-year results. The final chapter of FIDELITY is just around the corner – exciting times ahead!

Principal investigators

Project team

Mika Paavola – Antti Malmivaara – Simo Taimela – Roope Kalske

Contributors

Ari Itälä – Antti Joukainen – Heikki Nurmi – Juha Kalske – Martin Englund – Anna Ikonen – Timo Järvelä – Tero Järvinen – Kari Kanto – Janne Karhunen – Jani Knifsund – Heikki Kröger – Jaanika Kumm – Tommi Kääriäinen – Janne Lehtinen – Jukka Nyrhinen – Juha Paloneva – Outi Päiväniemi – Marko Raivio – Janne Sahlman – Roope Sarvilinna – Niko Sillanpää – Aleksandra Turkiewicz – Sikri Tukiainen – Ville-Valtteri Välimäki – Ville Äärimaa

Clinical research coordinators:

Ina Fagerlund – Saara-Maija Hinkkanen – Elina Jalava – Sari Karesvuori – Pekka Karppi – Johanna Koivistoinen – Kirsi Saarioja – Marja-Liisa Sutinen – Marketta Rautanen – Mari Routapohja

News

Publications

Osteoarthritis and Cartilage, 2024 Sep 12

Niko Sillanpää, Marika Iivanainen, Aleksandra Turkiewicz, Raine Sihvonen, Mika Paavola, Simo Taimela, Teppo Järvinen, Martin Englund

Clinical Orthopaedics and Related Research, 2024 Sep 1

Roope Kalske, Ali Kiadaliri, Raine Sihvonen, Martin Englund, Aleksandra Turkiewicz, Mika Paavola, Antti Malmivaara, Ari Itälä, Antti Joukainen, Heikki Nurmi, Pirjo Toivonen, Simo Taimela, Teppo L N Järvinen

British Journal of Sports Medicine, 2020 Aug 27

Raine Sihvonen, Mika Paavola, Antti Malmivaara, Ari Itälä, Antti Joukainen, Juha Kalske, Heikki Nurmi, Jaanika Kumm, Niko Sillanpää, Tommi Kiekara, Aleksandra Turkiewicz, Pirjo Toivonen, Martin Englund, Simo Taimela, Teppo Järvinen

Trials, 2020 Jan 14

Raine Sihvonen, Roope Kalske, Martin Englund, Aleksandra Turkiewicz, Pirjo Toivonen, Simo Taimela, Teppo Järvinen

Osteoarthritis Cartilage, 2019 Jul 23

Stefan Lohmander, Teppo Järvinen

Annals of the Rheumatic Diseases, 2018 Feb, Epub 2017 May 18

Raine Sihvonen, Mika Paavola, Antti Malmivaara, Ari Itälä, Antti Joukainen, Heikki Nurmi, Juha Kalske, Anna Ikonen, Timo Järvelä, Tero Järvinen, Kari Kanto, Janne Karhunen, Jani Knifsund, Heikki Kröger, Tommi Kääriäinen, Janne Lehtinen, Jukka Nyrhinen, Juha Paloneva, Outi Päiväniemi, Marko Raivio, Janne Sahlman, Roope Sarvilinna, Sikri Tukiainen, Ville-Valtteri Välimäki, Ville Äärimaa, Pirjo Toivonen, Teppo Järvinen

Nature Reviews Rheumatology, 2017 Jul 6

Teppo Järvinen, Gordon Guyatt

Osteoarthritis and Cartilage, 2016 Aug, Epub 2016 Mar 31

Raine Sihvonen, Martin Englund, Aleksandra Turkiewicz, Teppo Järvinen

Acta Orthopaedica, 2014 May 21

Teppo Järvinen, Raine Sihvonen, Martin Englund

Journal of Clinical Epidemiology, 2014 Feb 19

Teppo Järvinen, Raine Sihvonen, Mohit Bhandari, Sheila Sprague, Antti Malmivaara, Mika Paavola, Holger Schünemann, Gordon Guyatt

The New England Journal of Medicine, 2013 Dec 26

Raine Sihvonen, Mika Paavola, Antti Malmivaara, Ari Itälä, Antti Joukainen, Juha Kalske, Heikki Nurmi, Teppo Järvinen

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