Arthroscopic knee surgery is a popular treatment for osteoarthritis and other knee problems. But two recent studies have cast doubt on its value for many patients.
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One study of almost 200 patients with moderate to severe osteoarthritis found that arthroscopic surgery wasn't any better than medical and physical therapy for relieving pain and stiffness. Medical therapy included use of acetaminophen, nonsteroidal anti-inflammatory drugs, glucosamine or chondroitin sulfate, and hyaluronic acid injection. Half the patients received medication and weekly physical therapy for 3 months, plus instruction on twice-daily exercises to do at home. Patients in the other group received those treatments and arthroscopic surgery. After 2 years, both groups reported similar pain levels, physical function, and overall quality of life. Researchers say surgery was most beneficial for those with milder symptoms or large meniscus tears and shouldn't be routine for osteoarthritis.
Another study suggests that surgeons may be too quick to assume that meniscal tears are responsible for knee symptoms of unclear origin. Researchers used magnetic resonance imaging (MRI) to test 991 people ages 50 to 59 who were selected randomly (not on the basis of knee or other joint problems). They found that meniscal tears were common and not necessarily troublesome: In fact, about 60% of patients with meniscal tears that showed up on MRI hadn't experienced pain, aching, or stiffness in the previous month. Researchers concluded that incidental meniscal tears are common in the general population and the incidence increases with age. Experts speculate that using MRIs to diagnose knee problems may be leading to unnecessary surgeries or referrals to orthopedic surgeons.
Kirkley A, Birmingham TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. New Eng J Med. 2008;359:1097-1107; Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. New Eng J Med. 2008;359:1108-1115.