Sports Medicine

The Case Against – and for – Arthroscopic Knee Surgery

By Michael O. Schroeder, Staff Writer | June 22, 2017

The prospect of resolving nagging knee pain – or discomfort that’s come on fairly sudden – drives many patients to go under the knife, specifically to have an arthroscopic knee procedure done.

During the procedure, an orthopedic surgeon inserts a tiny camera – or arthroscope – through a small incision to view the inside of the knee. The doctor then attempts to surgically address the knee pain, such as making repairs to a torn meniscus – a C-shaped disc that cushions the knee – or realigning a misaligned patella or kneecap.

“There are some limited circumstances where it’s helpful,” says Dr. Reed Siemieniuk, an internist in Toronto and a doctorate student in health research methodology at McMaster University in Hamilton, Ontario. That includes young patients who have sports injuries, or tears in the ligaments of the knee, he says, and patients who have bleeding in the knee – to try to figure out where the bleeding is coming from and address that. The surgery could also benefit individuals of any age who’ve suffered a traumatic injury to the knee, such as a meniscus tear. An example of a good candidate for arthroscopic knee surgery would bea 30-year-old who twists his knee getting up from a seated position or while playing tennis, says Dr. Joseph Bosco, a professor and vice chair of the department of orthopedic surgery at NYU Langone Medical Center.

But a meta-analysis led by Siemieniuk of research on arthroscopic knee surgery strongly recommended against knee scoping “in nearly all patients with degenerative knee disease.” The clinical practice guideline was published in the BMJ in May. The analysis evaluated arthroscopic knee surgery for degenerative knee disease, which is often synonymous with knee arthritis. “It is knee pain or locking that occurs with use or overuse. The most common risk factor is being overweight or obese,” Siemieniuk explains. “We use the term degenerative knee disease rather than arthritis because some surgeons restrict the diagnosis of arthritis to those diagnosed by X-ray or MRI when in reality, many people have degenerative knee disease with normal X-rays and MRIs.” Meniscus tears are also a common finding in those with arthritis, or degenerative knee disease, and are not associated with knee symptoms, but are often used as a reason to operate, he adds.
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Drue De Angelis

Drue is Managing Partner for The De Angelis Group, Executive Search firm exclusively for the Ortho & Spine industry.

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