Knee Surgery Ineffective for Many Cases of Torn Cartilage

With minor variation, the following is an extremely common sequence of events. A man notices slowly worsening nagging knee pain that persists over months. He sees an orthopedist who examines him and orders an MRI. The MRI shows a tear in the medial meniscus. (The lateral and medial menisci are the cartilage pads that cushion the knee joint.) Pain medicine and physical therapy are prescribed but the pain persists. So the orthopedist recommends surgery and performs an arthroscopic partial meniscectomy. That’s the technical way of saying that with tiny instruments inserted into the joint through small incisions the doctor visualizes the cartilage tear and shaves away the loose and torn portion, leaving behind only solid intact cartilage. After the surgery more physical therapy is prescribed and over the subsequent months, the patient feels much better. Both he and his doctor agree that the surgery was a success.

This story repeats itself about 700,000 times annually in the U.S. amounting to direct costs of $4 billion. Partial mensicectomies are one of the most common orthopedic procedures. I certainly have never given it a second thought, and have sent patients to orthopedists expecting exactly this treatment. The assumption that the pain is caused by the cartilage tear is so compelling we don’t even notice it.

Previous studies have already shown that arthroscopic knee surgery is ineffective for arthritis. In patients with a cartilage tear and arthritis a study demonstrated that physical therapy and surgery was no better than surgery alone. But for cartilage tears without arthritis the belief remained that the problem was mechanical – the cartilage was torn – and therefore had a mechanical solution – cut away the torn fragment.

Last week’s New England Journal of Medicine (NEJM) published an ” target=”_blank”>Common Knee Surgery Does Very Little for Some, Study Suggests (New York Times)
” target=”_blank”>You may not be better off after knee surgery (CNN)
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