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The news tells us that arthroscopic surgery for knee arthritis and meniscal tears isn’t worth it. Healthcare Triage told you that a while ago. What’s new? This is Healthcare Triage News.

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Lots of recent news coverage tells us that arthroscopic surgery for knee arthritis and meniscal tears isn't worth it. Healthcare Triage told you that a while ago. What's changed? This is Healthcare Triage News.


Every year in the United States, people get about 650,000 arthroscopic surgeries. They cost an average of 5,000 dollars each. So, we're spending well over 3 billion dollars a year on these things.

About a year ago, still after our Healthcare Triage episode that talked about something similar, a randomized controlled trial was published in the BMJ. It took 140 men with degenerative medial meniscal tears, verified by MRI, and gave them one of two treatments. The first group got arthroscopic surgery. The second got twelve weeks of supervised exercise therapy.

They were both followed for two years, and the main outcome of interest was the knee injury and osteoarthritis outcome score, which measures pain, function in sports, and knee-related quality of life.

At two years, there were no clinically relevant difference between the two groups. At three months, the exercise group (not the surgery group) had increased muscle strength. There were no adverse events in either group.

But, surgery is so tempting! Almost one fifth of the exercise group eventually crossed over to the surgery group during the two year follow-up period. They received no additional benefits for their trouble.

Based upon these results, a panel of experts got together and released some new guidelines based on this and other research. That's what made the news in recent weeks. But, they won't surprise long-time viewers of Healthcare Triage.

They made a strong recommendation against the use of arthroscopy in pretty much all patients with degenerative knee disease. The evidence is so strong for this problem that they said it's really unlikely that research in the future could alter this recommendation.

This even applies to patients with imaging evidence of osteoarthritis, mechanical symptoms, or symptoms that come on suddenly. So think twice about those scans.

The evidence is so strong here that they recommended that people who watch the healthcare system, which includes us, look at the number of these surgeries performed in patients for these reasons as a quality metric, 'cause doing them is bad.

This isn't to say that all surgery should be shunned. Knee replacement works, but it's reserved for patients with the most severe disease, and only after other options have failed. Because, remember this, arthroscopic surgery of the knee is the most common orthopedic procedure performed in countries that collect data. Even with all of this evidence and all of the expense, it's the most popularly performed orthopaedic procedure around.


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