UPDATED Research: Arthroscopic knee surgery risks may outweigh benefits
According to the American Orthopaedic Society for Sports Medicine:
Arthroscopy for the knee is most commonly used for:
- Removal or repair of torn meniscal cartilage
- Reconstruction of a torn anterior cruciate ligament
- Trimming of torn pieces of articular cartilage
- Removal of loose fragments of bone or cartilage.
- Removal of inflamed synovial tissue that lines the joint capsules can lead to fluid accumulation in the knee.
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.
A study that challenges a surgical practice used for decades – debridement during arthroscopic meniscus surgery says it does not 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 in arthroscopic meniscus surgery. Listen to the results of the study:
Patients who did not have dislodged cartilage removed, recovered faster
“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)
- If you did not have debridement during arthroscopic meniscus surgery you:
- recover faster
- with less pain
- and will likely have identical results to those who had the cartilage bits shaved away.
“Those with less surgery got better faster in comparison with the people we did more surgery on”
“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 the University of Buffalo 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.
As mentioned, these were surprising findings so other researchers set out to support or disclaim these results.
Microfracture or surgical debridement of cartilage damage with ACL rupture: Helpful? Not helpful?
An August 2018 study in the Orthopaedic Journal of Sports Medicine (2) examined the effect of microfracture or surgical debridement of full-thickness cartilage tears that were injured at the same time the patient suffered a ruptured ACL (anterior cruciate ligament). The researchers compared microfracture or surgical debridement with no surgical treatment on patient-reported outcomes five years after anterior cruciate ligament reconstruction (ACLR).
The illustration here is that an injury significant enough to rupture an ACL would provide significant damage to the meniscus to likely warrant a surgery. The results, surgery to fix the meniscus damaged in this way, probably not helpful. Here is what the researchers said:
Results: Compared with no surgical treatment, there were no unadjusted or adjusted effects of microfracture or surgical debridement of concomitant full-thickness cartilage lesions on KOOS scores at 5-year follow-up. (The Knee injury and Osteoarthritis Outcome Score (KOOS) is used to help evaluate short-term and long-term symptoms of knee injury and function.)
CONCLUSION: Compared with leaving concomitant full-thickness cartilage lesions untreated at the time of anterior cruciate ligament reconstruction, microfracture or surgical debridement showed no effect on patient-reported outcomes five years after surgery.
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.(16)
- A full 60% of people who have no pain will show a meniscal tear on MRI! The net result is that the number of knee arthroscopies continues to rise because everyone with a knee problem qualifies for it!
16. 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]