Home E-Weekly May 30, 2017

Sham Knee Arthroscopy as Effective as Real Surgery?

Published: May 30, 2017

REAL PROGRESS Patients who had "placebo surgeries" improved just as much as those who had actual surgeries.

Patients rarely benefit from knee arthroscopy, according to a new study that calls into question the effectiveness of the most common orthopedic surgery performed on patients with degenerative knee disease.

At 24 months post-op, researchers evaluated 146 patients with degenerative medial meniscal tears but no evidence of knee osteoarthritis who underwent either arthroscopic partial meniscectomy (APM) or so-called sham surgery. Patients who had sham surgeries improved just as much as patients who underwent actual arthroscopies, reported Finnish researchers in Annals of the Rheumatic Diseases.

All 146 study participants had suspected meniscus tears that were later verified by MRI and knee arthroscopy, but 76 were given sham surgeries in which surgeons only simulated APMs, mimicking the sounds and sensations of surgery.

All patients had the same post-op care protocol, and all were evaluated 2 years later by an independent orthopedic surgeon who didn't know which were which, and who evaluated them for pain, range of motion, stability and other criteria.

The results "support the evolving consensus that degenerative meniscus tear represents an (early) sign of knee osteoarthritis, rather than a clinical entity on its own," say the authors. As such, they say, caution is warranted when "referring patients with knee pain and suspicion of a degenerative meniscal tear to MRI examination or APM, even after a failed attempt at conservative treatment."

Knee arthroscopy is performed 2 millions time per year worldwide, most often in middle-aged and older patients with knee symptoms and degenerative knee disease.

Jim Burger

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