Arthroscopic Surgery Ineffective for Degenerative Knee Disease

A new study challenges the effectiveness of arthroscopic surgery for degenerative knee arthritis and meniscal tears, and issues an updated clinical practice guideline.

Researchers at McMaster University, the University of Oslo, and a panel of international health experts conducted two systematic reviews to inform their recommendations regarding arthroscopic knee surgery. The reviews examined net benefit of knee arthroscopy compared with non-operative care pools data, derived from 13 randomized trials that included 1,668 patients, and an additional 12 observational studies for complications that included over 1.8 million patients.

The panel concluded that arthroscopic knee surgery does not, on average, result in an improvement in long term pain or function, and that most patients will experience an equal improvement in pain and function without arthroscopy. In all, less than 15% of study participants achieved a small or very small improvement in pain or function at three months after surgery, a benefit that was not sustained at one year. In addition, the panel warned that surgery exposed patients to rare but important harms, such as infection. The review was published on May 10, 2017, in BMJ.

“I think what’s important is that we need to look at the strongest evidence, which is a randomized controlled trial. Despite those personal experiences that say it might be doing good, the evidence suggests that it might not be doing any good,” said lead author Reed Siemieniuk, MD. “The panel’s reading of the studies suggests that on average, the pain relief that you’re getting is not going to be important to you at all.”

Arthroscopic knee surgery for degenerative knee disease is the most common orthopedic procedure in countries with available data, and on a global scale is performed more than two million times each year. Features advocated as responding positively to arthroscopic surgery and financial incentives may explain why arthroscopic knee surgery continues to be so common, despite recommendations against its use for osteoarthritis. In addition, many patients can be frustrated with their symptoms and failed treatments with less invasive management strategies, raising expectations of surgical management.