Carmen Heredia Rodriguez, Kaiser Health News – May 11, 2017
An international panel of surgeons and patients has challenged the effectiveness of one of the most common orthopedic procedures and recommended strongly against the use of arthroscopic surgery for patients with degenerative knee problems.
The guidelines, published Wednesday in the journal BMJ, reviewed 13 studies involving nearly 1,700 patients and found the surgery did not provide lasting pain relief or improve function for most of them. Those studies compared the surgery with a variety of options, including physical therapy, exercise and even placebo surgery.
Fewer than 15 percent of patients felt an improvement in pain and function three months after the procedure, and that those effects disappeared after one year, the review found. In addition, the surgery exposed patients to “rare but important harms,” such as infection.
Casey Quinlan, 64, who had the surgery in 2003 and was on the panel issuing the guidelines, said her orthopedist told her the procedure would not only help restore mobility in her knee after a nasty ski accident but also improve her arthritis.
Quinlan, of Richmond, Va., said the procedure did not deliver, since her arthritis remained unchanged. “It was not what I was told to expect,” she says.
In an arthroscopic knee surgery, physicians make several small incisions around the joint and insert a tiny camera that allows them to see inside the knee as well as insert small instruments to correct problems they identify. Often the surgery is performed to remove part of a damaged meniscus, a disc of cartilage that helps cushion the knee.
The panel said meniscal tears “are common, usually incidental findings, and unlikely to be the cause of knee pain, aching or stiffness.”