Knee arthroscopy has been commonly recommended for degenerative knee diseases, like osteoarthritis (OA) or meniscal tears. However, the results of a recent study by Hare et al.,2013 (1) in the British Medical Journal have blown holes in this belief. Their guidelines strongly recommend AGAINST arthroscopy for ‘nearly all’ patients with knee OA or meniscal tears.
Detailed data review reveals that knee arthroscopy has been the most common orthopedic procedure performed historically. Therefore, an international multidisciplinary panel including orthopedic surgeons, rheumatologists, physiotherapists, general practitioners, general internists, epidemiologists, methodologists, and people with real-life experience of degenerative knee disease met to discuss the evidence.
The Guideline put together by this panel strongly recommends against arthroscopic surgery in almost all patients with knee degenerative joint disease, based on linked systematic reviews. The authors also stated that further research is unlikely to alter this recommendation, further commenting that the arthroscopies performed in patients with degenerative knee disease are used as an indicator of quality care. This is heartbreaking because the short-lived benefits of pain reduction and increased function post-arthroscopic surgery are greatly outweighed by the financial burden, post-op limitations, and complications.
Besides, a systematic review and meta-analysis published by van de Graaf et al.,2016 (2) have strongly suggested conservative treatment as the best line of action for almost all patients with degenerative knee issues. They show benefits on par with arthroscopic surgeries.
The Summary
In summary, a more invasive procedure with an increased economic burden can be easily replaced with a non-invasive alternative with almost no economic burden while providing long-term benefits and a much better quality of life.
References:
1. Hare, K. B., Lohmander, L. S., Christensen, R., & Roos, E. M. (2013). Arthroscopic partial meniscectomy in middle-aged patients with mild or no knee osteoarthritis: a protocol for a double-blind, randomized sham-controlled multi-center trial. BMC musculoskeletal disorders, 14(1), 71.
2. van de Graaf, V. A., Wolterbeek, N., Mutsaerts, E. L., Scholtes, V. A., Saris, D. B., de Gast, A., & Poolman, R. W. (2016). Arthroscopic partial meniscectomy or conservative treatment for nonobstructive meniscal tears: a systematic review and meta-analysis of randomized controlled trials. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 32(9), 1855-1865.
