Study Questions Value of Certain Knee Surgeries
For age-related meniscus tears, physical therapy and meds may work as well as arthroscopy
By Kathleen Doheny
MONDAY, Aug. 25, 2014 (HealthDay News) -- Compared to conservative treatments, arthroscopic knee surgery offers no apparent benefit for middle-aged people with age-related tears of the meniscus -- the cartilage that cushions the knee joint, according to a new analysis.
This particular group of patients "may not benefit from rushing into arthroscopic surgery," said study researcher Dr. Moin Khan, chief resident of orthopedic surgery at McMaster University in Ontario, Canada.
Conservative treatment, such as anti-inflammatory medicine and physical therapy, should be tried first, the researchers said.
Arthroscopic knee surgery is common, with more than 700,000 of the minimally invasive procedures done each year in the United States, according to background information in the report.
In the surgery, also known as meniscal debridement, small keyhole-type incisions are made to remove fragments of the damaged meniscus. Complications can occur, the researchers noted.
Khan said experts have begun to realize that the surgery isn't helpful for everyone with knee damage. Some research has shown that those with severe arthritis and age-related tears in the meniscus don't benefit in the long run, he noted.
He wanted to see if that held true for those with less severe knee damage.
In the new analysis, published Aug. 25 in the CMAJ (Canadian Medical Association Journal), Khan and his colleagues looked at the findings of seven randomized controlled trials -- the gold standard in research. The studies included 805 patients, average age 56, with age-related meniscal tears and mild or no arthritis. Some had arthroscopic surgery, some had no surgery and others had sham treatments.
No differences were found in pain and functioning at six months or about two years later between the surgery patients and those who didn't have surgery.
"On a scale of 1 to 10 for pain, surgery did not result in a significant improvement, less than a 1-point difference," Khan said.
Functioning scores, which took into account how well patients could walk, climb stairs or go about daily activities, were also similar in each group, Khan said.
The conclusions apply only to those in their 50s who have mild arthritis of the knee and also age-related chronic tears of the meniscus, he said.