Two studies published in the September 11, 2008 issue of the New England Journal of Medicine (NEJM) raise some serious questions about the value of arthroscopic knee surgery. One study suggests that surgeons may be a bit too quick to assume that meniscal tears cause knee pain and symptoms of unclear origin (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;359:1108-15). Using MRI studies of 991 randomly selected people, researchers found that damage and tears to the meniscus were common and increased with age. Interestingly, the majority of tears (61%) were found in patients who had no knee pain, aches, or stiffness. MRI is often used to evaluate knee problems when a cause is not obvious. When meniscal tears are found, it is presumed the symptoms are related to the tear. No longer, if you take this fairly large population study at face value.

The second study compared arthroscopic knee surgery to medical and physical therapy in 178 patients with moderate-to-severe osteoarthritis of the knee. These researchers found that arthroscopic surgery was no better than optimized physical and medical therapy for osteoarthritis of the knee (Kirkley A, Birminghan TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. New Eng J Med. 2008;359:1097-1107). Medical therapy provided to 92 of the patients included nonsteroidal anti-inflammatory drugs, acetaminophen, chondroitin sulfate or glucosamine, hyaluronic acid injection, weekly physical therapy for three months, and instruction on twice-daily home exercises. The remaining 86 surgical therapy patients received the same medical treatments plus arthroscopic surgery (including debridement of cartilage and/or meniscus and excision or removal of loose bodies and osteocytes). After 2 years, both groups had similar pain levels, physical function, and overall quality of life scores. Arthroscopic surgery is a widely used treatment for osteoarthritis of the knee with no proven (scientific) benefit. This study provides some proof that it often has no benefit.

Some food for thought if you're having knee problems!

Mike McEvoy
EMS Technical Editor
Fire Engineering

Labels: EMS, knee, medical, surgery

posted by Mike McEvoy
12/20/2008 11:41:00 PM

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