Arthroscopic Knee Surgery for Meniscus Tear Carries Few Benefits: Study

Arthroscopic knee surgery may not be as effective for alleviating knee pain and repairing meniscus tears as doctors previously believed, according to the results of new research that suggests thousands of patients may be undergoing surgery unnecessarily.  

The study was published in the New England Journal of Medicine on December 26, 2013, finding that fake meniscus surgery provided the same benefits for knee pain and meniscus tear as undergoing actual menuscus surgery.

The new research builds on prior findings that have suggested meniscus surgery may not be of as much value as doctors and patients may believe.

Finnish researchers studied patients aged 35 to 65 years in five different hospitals. Every patient experienced knee symptoms consistent with degenerative medial meniscus tear, which include knee pain and mechanical problems, like locking and clicking in the knees.

Patients were randomly assigned to either real meniscus surgery while others underwent a fake surgery. Patients were given spinal anesthesia and remained awake.

Those who underwent meniscus surgery were given small incisions to accommodate the arthroscope. The ragged edges of the meniscus were then trimmed and smoothed with the edges of a shaver tool.

The fake surgery patients also received incisions, however bladeless shavers were rubbed on the outside of the kneecap to simulate the sensation of surgery.

One year after surgery, both groups of patients reported reduced knee pain. In fact, the majority of patients said they would undergo the same procedure again, even patients who underwent the faked surgeries.

“The outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure,” wrote study authors.

Arthroscopic meniscus surgery is a very common and one of the most popular surgeries performed in the United States. Nearly 700,000 meniscus surgeries are performed annually, costing nearly $4 billion.

The meniscus is a piece of crescent shaped cartilage in the knee that helps cushion and stabilize it. The surgery at issue is used to mitigate pain arising from a torn meniscus, but researchers say the surgery seems to have no significant benefits and may be no more beneficial than other treatments such as physical therapy and medication.

The study found no difference in the number of patients who required subsequent knee surgery or experienced adverse events. Two patients in the surgery group required follow-up surgery, while three in the fake surgery group needed follow-up surgery.

Researchers conclude meniscus surgery should be prescribed more sparingly and suggested physical therapy be tried first before surgery.

Certain factors, such as pain and whether the pain is caused by a tear or osteoarthritis should be considered. Other factors to be weighed include whether mechanical knee function is affected by the meniscus tear.

Doctors also recommend meniscus surgery should be aimed at younger patients who develop tears from acute sports injuries. Nearly 80% of tears develop from wear and aging.