Knee meniscus surgery is a bizarre topic for many orthopedic surgeons, sort of like a sacred cow crossing the road in India. While the high-level research continues to show that cutting out pieces of the knee meniscus doesn’t help patients, these surgeries are still common, and many surgeons will defend their use. However, when does the research become so overwhelming that all orthopedic surgeons have to give up routine meniscus surgery? Are we there yet? Another study was just published that again shows that the procedures can cause more harm than good.
The most common elective orthopedic surgery worldwide has had a rough run this past 15 years. It all began with the basic concept of a dirty room. When you place an arthroscopy scope in a knee with damage and arthritis, the “room” looks to be a mess. We all hate a messy room, so the first orthopedic surgeons to do this in the 1970s figured that “cleaning up” the mess would help. This procedure is called “debridement” or “cleaning up” the knee. There is just one little problem: in 2002, research was published comparing this surgery to a fake procedure. In the end, the operation couldn’t beat the results of a sham surgery. So “cleaning up the room” didn’t help.
This problem study was the first self-inflicted blow for the modern orthopedic surgery that demonstrated its inherent weakness: the research supporting that all of these invasive surgeries helped patients was the poorest of any medical specialty. In fact, the British Medical Journal classified it as “scandalously poor.” However, the 2002 study was just the beginning of a much bigger problem. The most common orthopedic surgery in the world, meniscus surgery, was about to have real issues.
Many patients believe that when they get meniscus surgery, the surgeon is repairing the structure. However, this only happens 4% of the time; the other 96% of the time, the torn piece is removed. So how well does this work? So far we have high-level research that shows that surgery for meniscus tears with or without arthritis doesn’t work. We also have studies that show that when there’s locking of the knee due to a meniscus tear, the surgery also fails to work. So much for meniscus surgery.
While overwhelming research has shown that meniscus surgery is a bust, many orthopedic surgeons refuse to yield on the topic. While the surgery may still be helpful for select patients, given our knowledge of how poorly it works, when will most meniscus surgeries be relegated to the dustbin of medical history?
A few years back, a study was presented at a national radiology meeting that showed that almost all patients who got meniscus surgery quickly ended up with arthritis. However, this study got little play. Now, new research using the data from a government-funded arthritis study shows more unpleasant meniscus surgery effects.
The new study looked at almost 5,000 patients who were middle aged to elderly and who were being tracked because they had arthritis. Just over 300 of these patients underwent meniscus surgery. It then matched those surgical patients to others who were similar, but who didn’t have surgery. The findings? The patients who had a meniscus procedure were three times as likely to need and get a knee replacement as those who did not!
The upshot? When will routine meniscus surgery become a thing of the past? Likely when insurance companies begin to deny coverage, which given the research, won’t be too far off.
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…