A review of middle-aged and mildly osteoarthritic patients indicates there is good evidence there are no benefits to arthroscopic knee surgeries following degenerative tears, according to findings published Monday in the Canadian Medical Association Journal.
“Weight loss, anti-inflammatory medications and physiotherapy… These are great options for middle-age patients,” said Dr. Moin Khan, lead author of the study and research fellow in McMaster's division of orthopedic surgery. “They should try them for at least three months before considering a surgical option.”
The study looked at six-month and two-year out reporting results of people who had arthroscopic surgery for age-related degenerative tears to the meniscus in their knee.
The researchers searched databases for randomized controlled trials (RCTs) published from 1946 to Jan. 20, 2014, assessed risk of bias for the studies and compared the results using a random-effects model. Seven RCTs involving 805 patients were included in the review.
The researchers found little evidence the tears were any different than not operating, or doing a placebo operation, known as a sham operation.
Sham surgeries, Khan explained, are only used in trial conditions, and involve surgeons making a small incision but not performing surgery on the knee.
Khan said that arthroscopic knee surgeries to repair meniscal tears are a pervasive surgery with some 700,000 performed annually in the U.S. alone. He estimated “tens of thousands” are performed in Canada.
The Canadian Arthritis Society said osteoarthritis affects nearly three million people, or one in 10 Canadians.
What's causing the pain?
The question is, however, is the tear or the arthritis causing the pain?
“It's difficult to say,” Khan said. "There can be many pain generators in the knee such as the meniscus, arthritis or a combination of both. A finding of a meniscal tear on an MRI scan doesn't necessarily mean that is the source of a patient's pain so operating to remove it will not necessarily help with a patient's symptoms."
What is clear is the surgery isn’t helping — not in the short term, or in the long term.
Khan’s research is now focused on hip surgeries, looking at similar factors to see if surgery is the best method.
He said these surgeries cost taxpayers money, but above all, doctors should want to know best practices, and that his findings have been well received at McMaster.
“If you're middle-aged in your fifties, and you have knee pain and you've found a chronic age-related tear, talk to your doctor… Maybe try three months of conservative treatment… before going for a surgery,” Khan said.