Articles Posted in Surgery Analyses

A Finnish study recently published in the New England Journal of Medicine questions whether meniscectomies, the surgical repair of the meniscus, are effective in treating torn menisci of the knee. The meniscus is a cartilage of the knee that acts as a shock absorber, along with other parts of the knee including the anterior cruciate ligament. The meniscus is located between the femur, (also known as the thigh bone and which is the largest bone in the leg) and the tibia, which is the larger of the two bones in the lower leg, with the other being the fibula.

In a partial meniscectomy, small incisions are made in the knee to permit an arthroscope (a small surgical camera) to see inside the knee. A tool known as a “shaver” is then used to trim torn meniscus and to smooth the edges of the remaining cartilage. The most common orthopedic surgery in the U.S. is the meniscectomy. Annually, approximately 700,000 arthroscopic surgeries on the knee are performed in this country.

In the study, involving five hospitals and 146 patients ages 35 to 65, they were diagnosed with wear induced meniscus tears, not traumatically induced from sports related injuries or a personal injury accident. All the subjects received incisions and anesthesia. Some in the study actually received the surgery, and others were given “fake surgery”, in which bladeless shavers were rubbed against the outside of the patella (kneecap) to simulate the sensation of having an actual meniscectomy. One year after the study, the group who had the surgery reported the same improvement in the knee as the group that did not have any surgery at all. One of the participating doctors in the study acknowledged the placebo effect, but stated that the placebo effect could not account for the significant results of the study.

Thus, the question is, did the meniscectomy make any difference at all? One issue to be determined is whether the patient’s pain is caused by the torn meniscus, or another factor such as osteoarthritis, which is often seen in patients with tears. Orthopedists often do not know for sure if the meniscus tear is causing the patient pain, and, if the tear is the cause of pain, whether the surgery will alleviate the pain. In 2002, another study in Texas showed that patients who were treated with arthroscopy for osteoarthritis did not have had any better outcomes than those who received “sham surgery.” In 2008, a Canadian study determined that patients who underwent surgery for knee arthritis had similar results to those who were treated with physical therapy and pain medications. As a result, many surgeons stopped performing surgery on patients who were only suffering from arthritis of the knee.

As a result of the above studies, it is certainly a wise decision to seek second and possibly third opinions before undergoing a meniscectomy for a torn meniscus, as orthopedist clearly cannot say for sure that the pain is coming from the tear or if the repair will truly alleviate the pain. In many cases, physical therapy and pain medication may be the better option.

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A report in the New England Journal of Medicine confirms a 2002 study that arthroscopic knee surgery is not effective in reducing the joint pain or stiffness associated with arthritis. Arthritis is caused when cartilage that protects bones at the joints (knee, hips, shoulders, hips) wears down abnormally, causing pain and stiffness due to the bones rubbing together. Arthritis affects approximately 27 million Americans, usually beginning after age 40.

Arthroscopic knee surgery is a technique in which the surgeon is aided by images from a camera in the joint. It is most commonly used in repairing injuries such as ligament and cartilage tears. in 2006, there were 985,000 arthroscopic knee surgeries in the United States, according to figures for the Centers for Disease Control and Prevention. Of those surgeries, approximately 200,000 to 300,000 were performed to treat arthritis.

The study in question examined 178 adults with moderate to severe arthritis who underwent arthroscopic surgery, during which bone and cartilage are removed with tiny incisions. The main conclusion, as stated by Dr. David McAllister, associate professor of orthopedic surgery at UCLA, is that: “…for this level of arthritis, surgery is not any better than nonsurgical treatment…[including physical therapy].”