New Warning About Arthroscopic Knee Surgery

By Pat Anson, Editor

Yet another study is warning against arthroscopic knee surgery, a common orthopedic procedure performed worldwide over two million times a year and at a cost of $3 billion in the U.S. alone.

An international panel of surgeons, physical therapists and clinicians reviewed 25 studies involving nearly two million patients and concluded that arthroscopic knee surgery does not improve long term pain or function in patients with degenerative knee conditions such as osteoarthritis.

Some patients may feel a small amount of pain relief three months after surgery, but the panel said the benefit was usually not sustained after one year.

“We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; further research is unlikely to alter this recommendation,” the panel reported in the British Medical Journal (BMJ).

The one exception raised by the review is for people with mechanical locking or clicking symptoms in their knee, which is often caused by meniscal tears in the cartilage of the knee joint.

Knee arthroscopies are a type of “keyhole” surgery in which the surgeon makes a small incision in the knee and inserts a tiny camera and instruments to diagnose and repair damaged ligaments or torn meniscus. Risks associated with arthroscopic knee surgery, although rare, include deep vein thrombosis (DVT), infection, pulmonary embolism, and death.

Over the past decade, the number of arthroscopic knee surgeries have soared in many Western countries where the population is aging. About 25 percent of people older than 50 experience  pain from degenerative knee disease.

SOURCE: THE BMJ

SOURCE: THE BMJ

Over the past decade, the number of arthroscopic knee surgeries have soared in many Western countries where the population is aging. About 25 percent of people older than 50 experience  pain from degenerative knee disease.

Previous studies in The BMJ found the benefits of knee surgery “inconsequential” and said the procedure was “not an economically attractive treatment option” compared to physical therapy, exercise and pain medication.

The studies are part of The BMJ's “Too Much Medicine” campaign, which highlights the waste of resources and potential harm caused by unnecessary medical care.

A 2014 report by a German health organization also found that arthroscopic knee surgery provides no benefit to patients with osteoarthritis, and does not relieve pain any better than physical therapy or over-the-counter pain medications. The same conclusion was reached by a large study in Australia.

The American Medical Society for Sports Medicine (AMSSM) lists arthroscopic knee surgery as one of five procedures that are not always necessary in the Choosing Wisely campaign. The AMSSM advises physicians to avoid recommending knee arthroscopy as a treatment for patients with degenerative meniscal tears.

Depending on insurance, hospital charges and the surgeon, arthroscopic knee surgery costs about $4,000.