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Tag: Arthroscopic surgery

  • Question your doctor before getting arthroscopic knee surgery

    Question your doctor before getting arthroscopic knee surgery

    If your doctor recommends you get arthroscopic knee surgery for a meniscal tear, do some homework before moving forward with the operation. A new Johns Hopkins study published in JAMA reveals that even though arthroscopic partial meniscectomies (APMs) have no benefit whatsoever for people over 65, surgeons perform these procedures routinely. And, as with much surgery, there are risks of infection and complications.

    Researchers studied Medicare data on 121,624 knee arthroscopies for meniscal tears that developed with age. It is one of the most common procedures for older adults, performed by 12,504 surgeons. Yet, many clinical trials have shown that the procedure unequivocally has no benefit in treating this degenerative disease in older adults.

    In general, the clinical trials reveal that routine exercise and physical therapy provide additional benefits for meniscal tears in older adults. Surgery, by comparison, offers no benefit. However, for acute traumatic meniscal tears, often resulting from engaging in sports, the APM can be beneficial.

    Notwithstanding the evidence against arthroscopic knee surgery for meniscal tears in older adults, thousands of surgeons continue to perform the procedure, jeopardizing people’s health and driving up health care spending unnecessarily. Perhaps, the surgeons have not seen the evidence or, perhaps, they choose to disregard it. Either way, the question is what is to be done about it.

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  • For knee pain, avoid arthroscopic surgery

    For knee pain, avoid arthroscopic surgery

    Kaiser Health News reports that international health experts and patients say that for knee pain its best to avoid arthroscopic surgery. According to the study published in BMJ, people with degenerative knee disease, that is osteoarthritis, or tears to their meniscus, are better off with exercise and therapy than with surgery.

    Years ago, I looked into this after a meniscal tear myself (a meniscus is a piece of cartilage that acts as a cushion between bones in the knee). Injuries to menisci often get better with physical therapy, anti-inflammatory medicine like ibuprofen, and maintaining a healthy weight. More serious injuries such as ruptures of anterior cruciate ligaments (ACL) which I also managed to do, require surgery if one is going to continue in a sports career or participate in an activity that puts torsion on the knee such as skiing.

    But for many of us, again, physical therapy and keeping the muscles strong around the knee and body weight under control may be the better choice, as studies show that those who have surgery have three times the risk of developing osteoarthritis later. As with many studies, there is a caveat. The higher risk of osteoarthritis may be related, as the study cited notes, to repeated injuries, since people who get the surgeries may do so in order to continue in activities that may cause them to re-traumatize their knees.

    To arrive at this recommendation, researchers looked at 13 studies of 1,700 patients who received arthroscopic surgery. They found that the overwhelming majority of these patients neither gained relief from their pain nor improved mobility from the surgery.  The small fraction who did see improvement in function or pain relief a few months following the surgery did not see it last for more than a year.

    In addition, surgery always has attendant risks, including infection.

    Arthroscopic knee surgery entails a few small cuts around the knee that permits the surgeon to see inside with a small camera and remove any damaged tissue or cartilage. It is a common procedure for repairing meniscal and ACL tears.  It is generally not recommended for patients with arthritis since it has not been found to reduce arthritic pain.

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