Study Questions Value of Certain Knee Surgeries

For age-related meniscus tears, physical therapy and meds may work as well as arthroscopy

By Kathleen Doheny
HealthDay Reporter

MONDAY, Aug. 25, 2014 (HealthDay News) -- Compared to conservative treatments, arthroscopic knee surgery offers no apparent benefit for middle-aged people with age-related tears of the meniscus -- the cartilage that cushions the knee joint, according to a new analysis.

This particular group of patients "may not benefit from rushing into arthroscopic surgery," said study researcher Dr. Moin Khan, chief resident of orthopedic surgery at McMaster University in Ontario, Canada.

Conservative treatment, such as anti-inflammatory medicine and physical therapy, should be tried first, the researchers said.

Arthroscopic knee surgery is common, with more than 700,000 of the minimally invasive procedures done each year in the United States, according to background information in the report.

In the surgery, also known as meniscal debridement, small keyhole-type incisions are made to remove fragments of the damaged meniscus. Complications can occur, the researchers noted.

Khan said experts have begun to realize that the surgery isn't helpful for everyone with knee damage. Some research has shown that those with severe arthritis and age-related tears in the meniscus don't benefit in the long run, he noted.

He wanted to see if that held true for those with less severe knee damage.

In the new analysis, published Aug. 25 in the CMAJ (Canadian Medical Association Journal), Khan and his colleagues looked at the findings of seven randomized controlled trials -- the gold standard in research. The studies included 805 patients, average age 56, with age-related meniscal tears and mild or no arthritis. Some had arthroscopic surgery, some had no surgery and others had sham treatments.

No differences were found in pain and functioning at six months or about two years later between the surgery patients and those who didn't have surgery.

"On a scale of 1 to 10 for pain, surgery did not result in a significant improvement, less than a 1-point difference," Khan said.

Functioning scores, which took into account how well patients could walk, climb stairs or go about daily activities, were also similar in each group, Khan said.

The conclusions apply only to those in their 50s who have mild arthritis of the knee and also age-related chronic tears of the meniscus, he said.

Kahn said the findings don't apply to people who have "acute" tears, those caused by injury, for instance.

"I think surgeons will look on this [finding] favorably, as we all want to do what is best for the patient," he said.

The new analysis reflects the findings of other research, said Dr. Leon Popovitz, an orthopedic surgeon at Lenox Hill Hospital in New York City, who wasn't involved in the study.

"Studies are changing the perspective of knee arthroscopy," he said. "While it used to be thought all meniscal tears need arthroscopic surgery, it's just not the case."

Popovitz tells patients, "If you do have the beginnings of arthritis and a meniscal tear and don't have mechanical symptoms, you really need to exhaust all conservative measures before pursuing arthroscopic surgery."

Some patients eventually will need the surgery, Popovitz said, but some could be spared.

It's still "an excellent operation" that can help many people, he added, "especially those who do not have arthritis."

Doctors can identify arthritis in the knee by X-ray, Popovitz said.

Dr. Mohit Bhandari, a co-author of the paper, reports consultancy payments and grant support from medical device makers and biopharmaceutical companies.

More information

To learn more about knee arthroscopy, see the American Academy of Orthopaedic Surgeons (http://orthoinfo.aaos.org/topic.cfm?topic=A00299 ).

SOURCES: Moin Khan, M.D., chief resident, orthopaedic surgery, McMaster University, Hamilton, Ontario, Canada; Leon Popovitz, M.D., orthopedic surgeon, Lenox Hill Hospital, New York City; Aug. 25, 2014, CMAJ (Canadian Medical Association Journal)

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