Knee Surgery Not an Effective Fix for Joint Pain, Study Claims

Got a bum knee?Time to rethink your treatment options:Finnish researchers claim physical therapy can relieve joint pain just as well as arthroscopic surgery.

The unusual study involved patients with a torn meniscus, a crescent-shaped cartilage that helps cushion and stabilize the knee. Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed roughly 700,000 times annually at an estimated cost of $4 billion.

The study, conducted in Finland, involved a small subset of meniscal tears. But experts, including some orthopedic surgeons, said the study added to other recent research suggesting that meniscal surgery should be aimed at a narrower group of patients; that for many, options like physical therapy may be as good.

The study randomized people to receive either the meniscussurgery or a “sham” procedure; researchers found no difference between pain symptoms or other measures of quality of life between the two groups.

“These results argue against the current practice of performing arthroscopic partial meniscectomy in patients with a degenerative meniscal tear,” concluded the study’s authors in the new research, published Dec. 26 in The New England Journal of Medicine.

The meniscus consists of two C-shaped pieces of cartilage that act as “shock absorbers,” between the femur, or thighbone, and tibia, or shinbone. Tears often occur during sports, such as when players squat or twist the knee, and older people are more prone to tears because the cartilage weakens and stretches thin over time.

For the surgery, a doctor inserts an instrument with a tiny camera attached to the end that projects the inside of the knee to a monitor, allowing doctors to remove the torn pieces of cartilage with surgical tools, including a mechanized shaver, inserted through another small incision.

The closed-knee procedure is thought to expedite recovery better than open-knee surgery, and with stability-building exercises, people can recover within weeks or months, according to the Mayo Clinic.

But according to authors of the new study, this surgery may be no better at relieving symptoms than rest, exercise and over-the-counter pain killers.

Finnish researchers enrolled 146 patients between the ages of 35 and 65 who had knee pain for at least three months in a trial in which they were randomized to either undergo an arthroscopic partial meniscectomy or a “sham” procedure that mimics an arthroscopy, in which a blade-less mechanized shaver was pushed up against the outside of the knee with suction in an operating room. The sham group was held in the operating and recovery rooms for the same amount of times as the surgery group, and all patients received the same walking aids and instructions for exercises, taking over-the-counter painkillers as required.

Participants were given questionnaires before surgery, and at months two, six and 12 after the procedures,to measure pain and quality of life. Though both groups showed improvements in symptoms from their baseline questionnaires to the 12-month follow-up, there were no significant differences between the real surgery group and the sham group.

Two tests were given to measure pain and quality of life using scores between zero and 100, with zero indicating the most severe symptoms and 100 indicating symptom-free. Doctors found the scores between these two tests fluctuated between groups by about 1.5 to 2.5 points, differences that could have been due to chance.

Patients in the sham-surgery group were not significantly more likely than patients in the partial-meniscectomy group to guess that they had undergone a sham procedure either.

“Although both groups had significant improvement in all primary outcomes, the patients assigned to arthroscopic partial meniscectomy had no greater improvement than those assigned to sham surgery,” wrote the study’s authors. They did note their study can’t be generalized to people who experienced traumatic tears to the meniscus, since the study focused on people who had wear and tear injuries.

Lead study author Teppo Jarvinen, M.D., a surgeon at the University of Helsinki in Finland, told Reuters that people”shouldn’t feel an obligation to seek help right away. You can just treat it with the conventional bag of tricks: painkillers, icing, losing weight, or slightly moderating your activities to make it a bit more tolerable.”

David Jevsevar, M.D., chair of the committee on evidence-based quality and value at the American Academy of Orthopaedic Surgeons, said the study provided more evidence that arthroscopy not always the best treatment option.

“We still think there’s benefit in arthroscopic meniscectomy in appropriate patients,” said Jevsevar, who was not involved in the study. “What we need to define in the future is what’s the definition of appropriate patient.”

But Craig Bennett, M.D., chief of sports medicine at the University of Maryland Medical Center, noted the findings may not be generalized to all people, since “sham” surgeries can be beneficial to those with swollen knees.

“If you scope the knee (without touching the cushion), that will often help even if you don’t completely address the torn meniscus issue,” he argued.