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Surgery to Remove Cartilage in the Knee: Not Effective!

POSTED ON IN Knee BY Chris Centeno


Surgery to Remove Cartilage in the Knee

Surgery to remove cartilage in the knee likely happens thousands of time each day. The surgeon pokes in the arthroscope and sees a cartilage flap, a piece of cartilage that is attached at one end and no longer connected to the bone. The doctor then shaves that piece of cartilage off. Why? No particular scientific reason other than it makes the dirty room of the knee look tidier. Now a new study shows that this doesn’t help at all and may hurt the knee.

This Has Been an Awful Decade for Orthopedic Knee Surgery

I saw some pics the other day on Twitter with a bunch of smiling residents and fellows taking an orthopedic knee surgery course. Some were likely learning how to perform surgery to remove cartilage in the knee. I had to chuckle a bit as none of them likely realize that the research train coming down the tracks will derail much of what they’re learning.

The beginning of the end began in 2002, when a Baylor orthopedic surgeon concluded a study that showed that “cleaning up” an arthritic knee (including taking pieces of cartilage and meniscus out) wasn’t effective. The surgeons at the time yelled that this was because of arthritis and that the more focused practice of removing parts of torn meniscus was still a good idea. Then more research was published showing the surgery didn’t work. The surgeons clamored that removing parts of a torn meniscus work well if there is no arthritis. Then another study was published showing that removing the meniscus also didn’t work in patients without arthritis. They exclaimed that the surgery was still needed for patients who had locking in the knee, until of course, a high-level study showed that procedure to be ineffective. Many have still clung to the idea that removing little pieces of cartilage that aren’t fully attached (cartilage flaps) in patients without widespread arthritis is an excellent idea. Until, of course, this new study.

Removing a Cartilage Flap Is a Bad Idea

The new study was a randomized controlled trial. First, it should be noted that the partial meniscectomy surgery on which the study is based has already been shown to be no better than a sham surgery. The patients all had an unstable cartilage injury with a flap and a meniscus tear. They were assigned to either have the cartilage flap surgically removed or not. While there was no difference in outcome at one year between the groups, the patients who didn’t have the cartilage removed actually did much better for the first six months. They had improved function within that time and had more muscle mass at six months.

Why Doesn’t Surgery to Remove Cartilage in the Knee Work?

The parts and pieces in a knee are there for a reason. Even when torn, they do a better job protecting the bone and joint than when they’re gone. So our silly penchant for removing things like meniscus and cartilage is more driven by our desire to make things look pretty than by common or scientific sense. SO NOTE TO ALL ORTHOPEDIC SURGEONS, STOP REMOVING STUFF FROM JOINTS BECAUSE IT LOOKS BAD. IT’S THERE FOR A REASON! LEAVE IT ALONE!

The upshot? Surgery to remove cartilage in the knee doesn’t work. This latest study now means that about 60–70% of all arthroscopic knee surgery is an elaborate sham. That now includes general lavage and debridement, meniscectomy for all indications, and limited debridement of torn cartilage. So when will insurers stop covering this stuff? That, of course, will exit the air from the room for these procedures. My guess is that given the mounting evidence, it won’t be long before the orthopedic knee surgery house of cards comes falling down.

    comments

    Aman K says

    the statement in the above article stating that removing and trimming off the miniscus in a non-arthritic knees did not work, seems inaccurate. Almost all arthroscopic surgeries on non-arthritic knees with miniscus tears are successful, but generally it is not successful on the knees with arthritic tears. Presently, I am contemplating whether I should have an arthroscopic surgery on my knee which has lots of arthritic tears or not.

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    Chris Centeno says

    Aman,
    The biggest issue with meniscus surgery is the removal of sections of the meniscus (which is what is done), both leaves the knee unstable leading to more wear and tear therefore arthritis, and leaves sections of the cartilage unprotected, leading to arthritis, evenin non-arthritic knees. Please see: https://www.regenexx.com/knee-meniscus-surgery-increases-odds-knee-replacement/

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    Tom says

    Hi regenexx team. I wondered what you're thoughts are on meniscus surgery in my unusual situation - a chronic bucket handle tear of the lateral meniscus in which the bulk of the posterior horn has detached and now sits over the anterior horn of that same meniscus (from MRI). It's not currently locking although it used to for years, now when it "goes" I get temporary sharp pain for a few seconds followed by a lot of stiffness and swelling for 3 days or so that means I can't bend/straighten the leg properly. I've been told given how long it's been going on (about 17 or 18 years) it's unlikely to be repairable. I'm currently making an appointment with GP to see if I can get a diagnostic arthroscopy as the only way they'll really know what's wrong is to have a look inside - the anterior horn looks about twice as thick as it should do on MRI because of the bit of posterior meniscus sitting on top of it (in theory I shouldn't be able to fully straighten that leg, like a coin in a door hinge blocking it maybe, except the difference is probably only a few degrees), I can't help but wonder if this extra piece at the front that's not supposed to be there was removed would I still have these episodes of pain/swelling though.

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    Chris Centeno says

    Tom,
    Thoughts are that you need the type of exam that can figure this out as removing things without understanding why they're there rarely helps. If you'd like to see if you'd be a Candidate and we can help, please submit the Candidate form. Please see this case of a "flipped buckethandle meniscus tear": https://www.regenexx.com/can-you-treat-a-meniscus-tear-without-surgery/

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    Berneta Layne says

    I did a tar and still not get it right two times to be exact can't lift my foot now they are going back in to tidy up what do you think I am now very scared

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    Chris Centeno says

    Berneta,
    We can undersand, as it sounds like you've been through a lot. But without examining you, or evaluating you for Candidacy, we can't advise on your specific case. If you would ike us to weigh in, please submit the Candidate from to the right of the blog.

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    Janet says

    Hi! I have a loose piece of cartilage/bone floating around in my knee which chipped off my knee cap. I cannot bend my knee all the way as something is stuck behind my knee (they assume it's this cartilage). I have to have a arthroscopy to remove this. How successful are these surgeries?

    replies

    Chris Centeno says

    Janet,
    Are you saying that your knee locks from time to time, or are you saying that at no time can you bend your knee fully?

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    About the Author

    Chris Centeno

    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.…

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