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When Evidence Says No, but Doctors Say Yes

Consider the knee, that most bedeviling of joints. A procedure known as arthroscopic partial meniscectomy, or APM, accounts for roughly half a million procedures a year at a cost of about $4 billion...

As people age, they often suffer tears in the meniscus that are not from any acute injury. APM is meant to relieve knee pain by cleaning out damaged pieces of a meniscus and shaving the cartilage back to crescent form. This is not a fringe surgery; in recent years, it has been one of the most popular surgical procedures in the hemisphere. And a burgeoning body of evidence says that it does not work for the most common varieties of knee pain.

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Featured

 Common knee surgery may do more harm than good: "I don't know how I would defend this procedure"

Thousands of Americans who undergo a common knee surgery might be making their problems worse rather than better. Researchers who followed patients for 10 years after they received either the actual procedure, arthroscopic knee surgery to trim degenerative cartilage tears, or merely "sham surgery" — a skin incision — for knee pain, found that the surgery provided little or no benefit and was, in fact, associated with accelerated osteoarthritis and higher rates of reoperation. That generally meant a total knee replacement.

Articles of Interest

Partial Meniscectomy: Everything You Need to Know

The meniscus acts as a shock absorber and helps to keep the knee stable. It can be damaged by an injury or by wear and tear over time. A partial meniscectomy, or trimming of the torn portion of the meniscus, can relieve pain and restore function.

Adverse outcomes after arthroscopic partial meniscectomy: a study of 700 000 procedures in the national Hospital Episode Statistics database for England

Arthroscopic partial meniscectomy is one of the most common orthopaedic procedures worldwide. Clinical trial evidence published in the past 6 years, however, has raised questions about the effectiveness of the procedure in some patient groups. In view of concerns about potential overuse, we aimed to establish the true risk of serious complications after arthroscopic partial meniscectomy.

Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear

Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.

Arthroscopic partial meniscectomy: did it ever work?

Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT?

Common Knee Surgery Does Very Little for Some, Study Suggests

A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports. The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees.

Common Knee Surgery May Help No More Than A Fake Operation

Go to the doctor with knee pain, and they might say you've got a meniscus tear and need surgery to fix it. But surgery for this common problem might not be any better at relieving pain than having no surgery at all, according to researchers who went to the trouble of performing fake surgery to find out.

Considering Bone or Joint Surgery? You May Not Need It

For many common problems of the knee, hip, shoulder, spine and wrist, nonsurgical options may be just as good.

Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears

The findings of this trial support the recommendation that exercise-based physical therapy should be the preferred treatment over surgery for degenerative meniscal tears.

Fake Knee Surgery as Good as Real Procedure, Study Finds

A fake surgical procedure is just as good as real surgery at reducing pain and other symptoms in some patients suffering from torn knee cartilage, according to a new study that is likely to fuel debate over one of the most common orthopedic operations.

Knee Surgery May Not Be the Best Option for Older Patients

Exercise and anti-inflammatory medications may be more effective for relieving pain from degenerative knee conditions in older patients.

Surgery is not always the best option for repairing a damaged meniscus

First, never consider having a surgical procedure without a second opinion from someone you trust. By this I do not mean a family friend, I mean someone with great credentials in your local community.

Watching My Surgeon Cut Into My Knee

What if the surgeon started slicing into my knee before it was completely numb? That was my biggest fear, while weighing whether to remain alert and watch the operation on the cartilage in my right knee, or to be put to sleep, preserving my peaceful ignorance.

What I Wish I’d Known About My Knees

Many of the procedures people undergo to counter chronic knee pain in the hopes of avoiding a knee replacement have limited or no evidence to support them. Some enrich the pockets of medical practitioners while rarely benefiting patients for more than a few months. I wish I had known that before I had succumbed to wishful thinking and tried them all.

Why ‘Useless’ Surgery Is Still Popular

The latest controversy — and the operation that arguably has been studied the most in randomized clinical trials — is surgery for a torn meniscus, a sliver of cartilage that acts as a shock absorber in the knee.

Resources

MeniscusTears.com

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StatPearls

Patients who have a reparable tear pattern in a vascular zone of the meniscus should have repair attempted as opposed to partial meniscectomy. Although there is contradictory evidence, it is generally recommended that older patients with degenerative meniscal tears may not benefit from arthroscopic partial meniscectomy as opposed to those with more acute, traumatic tears.