Research: For many, arthroscopic knee surgery does not work and in fact may be harmful

Ross Hauser, MD and Katherine L. Worsnick, MPAS, PA-C

Doctors and researchers are confirming arthroscopic knee surgeries for meniscus and cartilage “repair” do not heal, do not repair, and actually accelerate knee instability and the degenerative collapse of the knee.

Before you read on, do you have a question about Arthroscopic knee surgery for osteoarthritis? Get help and informmation from our Caring Medical staff

Numerous reports have been published in the medical literature which have all come to the conclusion that arthroscopic knee surgery does not work and in fact are harmful to many patients.

But what about all the positive results? Researchers give credit to the positive results of these surgeries to the PLACEBO effect. A placebo of course is NO medical treatment. As in the case for arthroscopic knee surgery, patients in these studies thought they had a surgery and they got better. The problem, they did not get a surgery, they only thought they did.

You can’t fight the evidence – arthroscopic knee surgery is NOT a stop gap to prevent the need for total knee replacement, it is an accelerant.

A study that challenges a surgical practice used for decades – debridement during meniscus surgery. It is doesn’t help patients

July 18, 2017. This is a portion of a press release from the University of Buffalo news center:

“A team of University at Buffalo medical doctors has published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.”

What they questioned was debridement, the cleaning out, clipping, or smoothing of any dislodged cartilage they found in the knee with the belief it was helping patients. These bits of cartilage are usually found incidentally is arthroscopic meniscus surgery.

But the new study finds that practice does not benefit the patient. Patients who did not have dislodged cartilage removed, recovered faster, with less pain, and ended up a year later with identical results.”

Here are the highlight points of this research published in The Journal of bone and joint surgery.(1)

“Those with less surgery got better faster in comparison with the people we did more surgery on,” said Leslie J. Bisson, MD, professor and chair in the Department of Orthopaedics at the Jacobs School of Medicine and Biomedical Sciences at UB and lead author of the study.

The finding was so surprising that an editor at The Journal of Bone & Joint Surgery, which published the study, also published a commentary that said, “The conclusion that unstable cartilage lesions do not need debridement could have a dramatic impact on practice management, save health-care dollars, and improve early patient outcomes.” University of Buffalo news center.

This research also suggests that the knee is a whole joint organ. What does this mean? Your knee heals its wholeself when it is injured. All the components of the knee act as one.

For our take on why removing damaged tissue may remove the healing elements found in the knee see my article Stem Cell injections for knee meniscus tears and post-meniscectomy.

Doctors issue warnings to Middle Age Patients – arthroscopic knee surgery accelerates osteoarthritis and NEED FOR KNEE REPLACEMENT

First, let’s look at research surrounding the use of arthroscopic knee surgery for middle-aged and older patients.

Published in the Annals of the rheumatic diseases, doctors from medical universities in Finland combined their research to publish these findings on Arthroscopic partial meniscectomy. For much more research on knee surgery for meniscus tears please see our article Knee Surgery for Meniscus Tears | Complications and Outcomes.

Here are the findings of the Finnish study:

Here is the conclusion of the study, what you will find is all the reasons people tell us they NEED arthroscopic knee surgery, are NOT supported

In conclusion, the results of this study showed Arthroscopic partial meniscectomy provides no significant benefit over placebo surgery in patients with a degenerative meniscal tear and no knee osteoarthritis.

Caution should be exercised in referring patients with knee pain and suspicion of a degenerative meniscal tear to MRI examination or Arthroscopic partial meniscectomy, even after a failed attempt of conservative treatment

As noted above this same team of researchers followed up on a previous study. As part of the Finnish Degenerative Meniscal Lesion Study Group their study in the medical journal Annals of Internal Medicine concludes:

Resection of a torn meniscus (cutting away tissue that cannot be sutured) has no added benefit over sham surgery to relieve knee catching or occasional locking. These findings question whether (these) mechanical symptoms are caused by a degenerative meniscus tear and prompt caution in using patients’ self-report of these symptoms as an indication for Arthroscopic Partial Meniscectomy.(3)

While these two studies demonstrate that arthroscopic surgery is no better than sham surgery, the same research team also published the landmark December 2013 study in The New England Journal of Medicine.(4)

The conclusion of this research which was heavily covered in the news media:

Dr. Shaw-Ruey Lyu, a noted Taiwanese researcher with specialty in problems of knee osteoarthritis noted in his paper published in the Annals of translational medicine that the above study since the number of Arthroscopic partial meniscectomy performed has been increasing, the information provided by this study should lead to a change in clinical care of patients with a degenerative meniscus tear.(5) We are going to return to this study later in this article.
Prolotherapy vs Surgery

More research warning middle-aged and older patients to avoid arthroscopic knee surgery

Research in the British Medical Journal was scathing: Here are their bullet points:

In an accompanying press release from the British Medical Journal, the research team issued these statements:

Here is more damning evidence for patients to avoid arthroscopy knee surgery and comes from two (May 2017) multi-national team studies from surgeons in the British Medical Journal.

Here are the bulletin points from this research:

In the first study, a panel led by Canadian researchers from McMaster University, and supported by data from doctors at the University of Toronto; University researchers in Australia; University Hospitals of Geneva, Switzerland; the Netherlands; Chile; Norway; and the United States, published the study entitled: Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline and made these recommendations:

Here is the summary given to surgeons:

The second study:
A new study that literally combed the world looking for the long-term benefits of knee arthroscopic surgery has been published in the British Medical Journal Open (on-line edition). In this research an international team of doctors including lead researchers from McMaster University in Canada, the Universidad de Chile, Monash University in Australia, University Hospital Basel, Switzerland, Kerman University of Medical Sciences in Iran, and the University of Oslo, Norway, tried to determine the effects and complications of arthroscopic surgery compared with conservative management strategies in patients with degenerative knee disease.

Here are the highlights of this research:

Arthroscopic knee surgery for osteoarthritis

According to the  American Orthopaedic Society for Sports Medicine:
Arthroscopy for the knee is most commonly used for:

As you will see in the research below – when meniscus and the articular cartilage, both of which are needed to help the femur bone glide smoothly over the tibia is removed, the bones do not glide properly.

Clearly, doctors are concerned that the wrong procedure was performed for these patients and made the patient’s condition worse.

But what were the circumstances that lead to this procedure?

Should the doctors not let what the patients are telling them help guide their treatments?

This is nonsensical because it is being speculated that the surgery did not work because doctors recommended a treatment  – arthroscopic procedure – based on what the patients told them about their symptoms?

Many past studies have concluded that surgery for osteoarthritis is not effective, not warranted, and basically should be avoided. So the idea is not new.

Arthroscopic knee surgery for osteoarthritis is not curative yet the numbers performed are increasing, is this the placebo effect?

Is arthroscopic knee surgery a placebo? In some of the studies referenced above and noted below, doctors are questioning whether the beneficial aspects of arthroscopic surgery reported in the literature were simply due to the placebo effect.

We are going back to the July 2017 published in the Annals of the rheumatic diseases from the Finnish university researchers:

“In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after placebo surgery.”(2)

In the study, the researchers did indeed perform placebo surgery. The doctors took 146 patients and randomized them into two group.

As stated above: “(they) found no statistically significant difference between the arthroscopic partial meniscectomy and placebo surgery for symptomatic patients with a degenerative meniscus tear and no osteoarthritis in any of the used outcome measures over the course of 24-month follow-up. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who failed initial conservative treatment are more likely to benefit from arthroscopic partial meniscectomy.”

The presence of mechanical symptoms – the justification of arthroscopic surgery – the loophole

All the research above has come to this conclusion, arthroscopic knee surgery for osteoarthritis is not curative. In summary, this agrees with the mounting level of evidence that arthroscopy doesn’t work any better than conservative care for most knee conditions, including degenerative arthritis. This is based on thorough research published in some of the most prestigious medical journals in the world and has changed how insurance companies reimburse for this procedure.

Almost every person with knee pain has some type of “popping” or crunching (also called crepitation) noise in these joints.

As we discussed above this could mean a patient could visit an orthopedist who documents mechanical symptoms in the patient’s knee and/or if the patient’s MRI shows any type of loose body or meniscal tear then arthroscopic surgery could be done and will be covered by insurance.

Let’s return to the study from Dr. Shaw-Ruey Lyu. In that research, Dr. Lyu asked:

MRIs can be misleading when diagnosing pain

The accidental finding of damage that is not causing the patient pain. Despite what a patient’s MRI will say, MRIs cannot always reveal the cause of the patient’s Knee Pain. Among persons with radiographic evidence of osteoarthritis, the prevalence of a meniscal tear was 63% among those with knee pain, catching, or stiffness on most days, and 60% among those without symptoms.(14)

 

Comprehensive Prolotherapy, PRP and Stem Cells

Degenerative Arthritis

Platelet Rich Plasma Therapy and Prolotherapy, which stimulates tendons, ligaments, and cartilage to heal, has many advantages over arthroscopy, which include:

These articles will provide more information about looking at options and alternativPlatelet-rich

Do you have a question about Arthroscopic knee surgery for osteoarthritis? Get help and informmation from our Caring Medical staff

References for this article Arthroscopic knee surgery for osteoarthritis

1 Bisson LJ, Kluczynski MA, Wind WM, Fineberg MS, Bernas GA, Rauh MA, Marzo JM, Zhou Z, Zhao J. Patient Outcomes After Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: The Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial. JBJS. 2017 Jul 5;99(13):1078-85. [Google Scholar]
2 Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Ikonen A, Järvelä T, Järvinen TA, Kanto K. Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial. Annals of the Rheumatic Diseases. 2017 May 18:annrheumdis-2017.[ Google Scholar] [-]
3 Sihvonen R, Englund M, Turkiewicz A, Järvinen TL. Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial Mechanical Symptoms and Arthroscopic Partial Meniscectomy. Annals of internal medicine. 2016 Apr 5;164(7):449-55.[Google Scholar:]
4 Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. New England Journal of Medicine. 2013 Dec 26;369(26):2515-24.[Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear]
5. Lyu SR. Why arthroscopic partial meniscectomy? Ann Transl Med. 2015 Sep;3(15):217. doi: 10.3978/j.issn.2305-5839.2015.07.04.[Google Scholar]
6. Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. bmj. 2015 Jun 16;350:h2747.[Google Scholar]
7. Siemieniuk RA, Harris IA, Agoritsas T, Poolman RW, Brignardello-Petersen R, Van de Velde S, Buchbinder R, Englund M, Lytvyn L, Quinlan C, Helsingen L. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ. 2017 May 10;357:j1982.[Google Scholar]
8. Brignardello-Petersen R, Guyatt GH, Buchbinder R, Poolman RW, Schandelmaier S, Chang Y, Sadeghirad B, Evaniew N, Vandvik PO. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ open. 2017 May 1;7(5):e016114. [Google Scholar]
9. Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ. 2014 Aug 25. pii: cmaj.140433.[Google Scholar]
10. Buchbinder R, Richards B, Harris I. Knee osteoarthritis and role for surgical intervention: lessons learned from randomized clinical trials and population-based cohorts. Curr Opin Rheumatol. 2013 Dec 26.[Google Scholar]
11. Spahn G, Klinger HM, Hofmann GO. The Effect of Arthroscopic Debridement and Conservative Treatment in Knee Osteoarthritis Sportverletz Sportschaden. 2013 Nov 6.[Google Scholar]
12. Moseley JB, O’malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine. 2002 Jul 11;347(2):81-8.[Google Scholar]
13. Siparsky P, Ryzewicz M, Peterson B, Bartz R. Arthroscopic treatment of osteoarthritis of the knee: are there any evidence-based indications?. Clinical orthopaedics and related research. 2007 Feb 1;455:107-12.[Google Scholar]
14. Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. New England Journal of Medicine. 2008 Sep 11;359(11):1108-15. [Google Scholar]

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