Arthroscopic surgery on knees--forget it

In arthroscopic surgery, a procedure that was started in the 1970s, the surgeon makes a couple of small incisions in the knee and inserts a fiber-optic arthroscope to take a look around, then washes out the joint with about ten quarts of saltwater to remove bits of cartilage, bony fragments, calcium crystals, and inflammatory cells.  He or she may also smooth out frayed cartilage and meniscus that cover the top and sides of the knee.

By 2002, fourteen studies had shown that arthroscopic surgery offered substantial pain relief. None, however, compared people who had had the arthroscopic surgery with those who hadn’t. In 2002, however, researchers at the Houston Veterans Affairs Medical Center and Baylor College of Medicine attempted to make this comparison using three groups of patients—180 in all. Two thirds had arthroscopic surgery, either just the washing or the cartilage cleanup. One third had a sham surgery: incisions, but nothing else (although the medical team acted as though they were performing all the treatments). One surgeon, the orthopedic surgeon for an NBA team, performed all procedures.

During the next two years the patients were evaluated for knee pain and function. It turns out, there was no difference in outcome. As reported in the New England Journal of Medicine, editors wrote, “Although smoothing cartilage and meniscal irregularities may sound appealing, larger forces within and outside the joint environment, such as malalignment, muscle weakness, instability, and obesity, which are not addressed by this type of surgery, may have greater effects on the clinical outcome…[the procedures] may simply remove some of the evidence while the destructive forces continue to work.”

Since then, according to my source, Dr. Paul Offit, “…fourteen randomized, controlled clinical trials and twelve observational studies, involving 1.8 million people, found that arthroscopic surgery for knee arthritis, with or without repair of a torn meniscus, was no better than physical therapy alone. Arthroscopic surgery, therefore, is no longer recommended for the treatment of knee arthritis. Yet, it remains one of America’s most common outpatient surgical procedures.” 

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