Arthroscopic knee surgery is an odd hybrid of old-school “cut it out” thinking paired with new technology. It caught on like wildfire in the 1980s because doctors and patients alike were attracted to the idea of eliminating the need for large incisions required for traditional surgery. A recent study sets out to quantify the arthroscopic knee surgery risks and benefits. Research published June 16, 2015, in the British Medical Journal concluded that this type of routine surgery isn’t all that effective when compared with its risks.
The basic concept of arthroscopic knee surgery is logical. Using two small incisions to insert both a camera to see what you’re doing and surgical instruments has to be an improvement over opening up the whole joint. Recovery time is shorter, fewer important structures need to be cut, and less time under anesthesia all are positive things for patients. The problem concerns how the technology actually is being used, as well as the lack of accurate information being given to patients. Studies show that meniscus tears found on MRI most often are not responsible for pain or lack of function in the knee. Rather than repairing these tears, doctors actually are removing chunks of the meniscus. Obviously, removing parts of a stabilizing shock absorber from a joint—especially if the stabilizer is not even causing a problem—is unwise.
The recent study in the British Medical Journal was a cross-sectional review of nine important studies of middle-aged to older knee-pain patients with or without osteoarthritis of the knee. The patients underwent arthroscopic knee surgery for debridement or for menisectomy. The subjects of the studies were evaluated at points from three to 24 months after their procedure. The results showed a measly 2.4 percent decrease in pain at three to six months, and the decrease in pain disappeared entirely beyond that point. There was no increase in function, and 4.2 percent of the patients, despite receiving little benefit, were harmed. These surgically induced injuries included deep vein thrombosis, pulmonary embolism, and infection. The authors concluded that the very small and temporary decrease in pain compared with the harm done makes arthroscopic knee surgery an inappropriate treatment for middle-aged and older patients.
This research only considered risks versus benefits of the surgery itself. Every day doctors see the damage and loss of function left behind from arthroscopic knee surgery. Cutting things out when there is no benefit makes no sense, especially when studies show that physical therapy often has similar results with none of the risk.
“Arthroscopic Knee Surgery Risks Vs. Benefits” first appeared as a post on the Regenexx blog.