Arthroscopic Surgery: Busting the myth.

Knee arthroscopy has been commonly recommended for patients with degenerative disease of the knee like osteoarthritis (OA) or meniscal tears. However, the results of a recent study by Hare et al.,2013 (1) in the British Medical Journal has blown holes in this belief with their guidelines strongly recommending AGAINST arthroscopy for ‘nearly all’ patients with knee OA or meniscal tears.

Detailed data review reveals that historically, knee arthroscopy has been the most common orthopedic procedure performed. 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 degenerative joint disease of the knee, based on linked systematic reviews. The authors also stated that further research is unlikely to alter this recommendation further stating that the arthroscopies performed in patients with degenerative knee disease are used as an indicator of quality care. This is heartbreaking given the fact that 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.

In addition, a systematic review and meta-analysis published by van de Graaf et al.,2016 (2) has strongly suggested conservative treatment as the best line of action for almost all patients with knee degenerative issues as 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-centre 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.

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