This week from Dr. Cerami and Utah Sports and Wellness


From: British Journal of Sports Medicine, March 2018

Quick Summary:

Approximately 25% of people older than 50 years’ experience pain from degenerative knee disease. The most common procedure for this is arthroscopic knee surgery, with more than 2 million surgeries performed each year globally. While these numbers are impressive, there is accumulating evidence that suggests this surgery does not on average, provide improvement in long term pain or function. Even finding that for patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy.



This study is a systematic review on the net benefit of knee arthroscopy compared with non-operative care pools data from 13 randomized trials for benefit outcomes (1,668 patients) and an additional 12 observational studies for complications (>1.8 million patients). These authors reviewed all available randomized trials that assessed the benefits of knee arthroscopy compared with non-operative care and observational studies. The question asked by an international expert panel was: What is the role of arthroscopic surgery in degenerative knee disease? “Our panel including orthopaedic surgeons, a rheumatologist, physiotherapists, a general practitioner, general internists, epidemiologists, methodologists, and people with lived experience of degenerative knee disease.”


These authors also note:

  • “Many patients experience important and marked improvements after arthroscopy, which may be erroneously attributed to the effects of the procedure itself instead of the natural course of the disease, co-interventions, or placebo effects.”
  •  “In <15% of participants, arthroscopic surgery resulted in a small or very small improvement in pain or function at 3 months after surgery; this benefit was not sustained at 1 year.”
  • “In addition to the burden of undergoing knee arthroscopy, there are rare but important harms.”
  • The only group of patients that might derive some benefit from arthroscopic knee surgery is those who are “objectively unable to fully extend their knee (that is, a true locked knee).”
  • With arthroscopic knee surgery “there is evidence of harm and no evidence of important lasting benefit in any subgroup.”
  • “Degenerative knee disease is a chronic condition in which symptoms fluctuate. On average, pain tends to improve over time after seeing a physician for pain and delaying knee replacement is encouraged when possible.”
  • “Our strong recommendation against arthroscopy reflects a low value on a modest probability (<15%) of small or very small improvement in short term pain and function that does not persist to 1 year, and a higher value on avoiding the burden, postoperative limitations, and rare serious adverse effects associated with knee arthroscopy.”
  • “This study adds to the body of evidence suggesting that the benefits of arthroscopy may not outweigh the burden and risks.”