Is Arthroscopic Knee Surgery Unnecessary?

Some 2 million people undergo arthroscopic knee surgery each year.  The procedure involves making slits in the skin around the knee joint, and then using a tiny camera and surgical instruments to repair damage to the knee joint – usually tears in the knee cartilage.

Over the past decade, mounting evidence has questioned whether arthroscopic knee surgery is effective at relieving the knee pain associated with aging joints. A clinical review guideline published this year in the British Medical Journal recommends that doctors not perform the surgery in the vast majority of patients.

The guideline is based on a systematic review of 12 clinical trials and 13 observational studies that compared arthroscopic knee surgery to managing knee pain with physical therapy and medications.  It found the surgery did not provide lasting pain relief or improved knee function. Some patients – about 15 percent – noticed small improvements three months after the surgery, but those disappeared within a year.

But patients who underwent physical therapy, used pain relievers and avoided activities that aggravated their knee pain saw improvements in pain and function, and did not face any of the risks associated with surgery, such as infections, blood clots or reactions to anesthesia.

The clinical review guideline goes as far to say that health organizations should measure the quality of care they provide by how many of these surgeries are performed at their facilities each year; facilities who perform large numbers of arthroscopic knee surgeries are providing a lower quality of care.

The take-home message: Arthroscopic knee surgery is ineffective for the vast majority of people with cartilage tears and degenerative knee disease.

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