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Arthroscopic Knee Surgery: Is it Really Necessary?

By David Thut, MD

You may have noticed a recent article in the New York Times discussing the indications for surgery for meniscus tears. In light of a recent article in the New England Journal of Medicine, the author makes the argument that many of the 700,000 arthroscopic knee surgeries done each year may be unnecessary. I agree that this is likely the case, though I doubt it is as big a problem as the New York Times suggests. It is very important for patients and their surgeon to be absolutely clear about the possible benefits and risks of the surgery prior to Smart going to the operating room.

I under find that patients who have had knee scopes are often unclear about the reason they underwent the procedure. Most will tell you that they had surgery to “repair torn cartilage.” The confusion stems from the fact that there are two different types of cartilage in the knee. The first, articular cartilage, is like a veneer on the end of the bones that forms a smooth gliding surface allowing the knee to have fluid motion. As that articular cartilage wears, it becomes thin and rough. The resulting arthritis causes pain in the knee. The second type of cartilage is meniscus cartilage. There are two menisci, which are semicircular rubbery structures that help spread the forces of bearing weight in order to protect the articular cartilage. Most knee arthroscopic procedures are done to remove torn portions of Is the meniscus.

When a young person with no arthritis sustains an injury that causes a meniscus tear, he or she often experiences pain caused by that tear. When the rest of the knee is normal, knee arthroscopy to remove the torn part of the meniscus can improve the injury-induced pain.

Patients with arthritis have thinning of the articular cartilage and often experience degenerative meniscus tears. For years, surgeons performed a “clean up” knee scope to remove torn meniscus prior to considering wholesale nfl jerseys knee replacement. Two studies published about 10 years ago showed us that in most cases patients who have degenerative meniscus tears do not benefit from knee arthroscopy. The pain is caused by the arthritis, not by the meniscus tear. Most surgeons have stopped offering arthroscopic surgery to treat meniscus tears in a severely arthritic knee.

The science is clear: pain in a healthy knee with a tear resulting from acute injury is very likely to respond to arthroscopy while pain associated with a tear in a severely arthritic knee is not. With cases that fall into the And middle ground, medicine Botanera becomes an art. When a knee has some degenerative change of the articular cartilage, and some degenerative tearing of the meniscus, the benefits of surgery become harder to predict. For these patients, options include medication, injection, physical wholesale nfl jerseys therapy, weight loss, and arthroscopy. While knee arthroscopy is a very safe procedure, it carries more risk than the other options. The study discussed in The New York Time reinforces the idea that, for degenerative meniscus tears, surgery should be the last resort.

For most patients with knee pain, x-rays should be cheap nba jerseys the first study ordered. If there is any visible arthritis, patients should start with interventions like physical therapy, over- the-counter wholesale mlb jerseys medicine and possibly injections. If these interventions fail, consideration should be given to cheap jerseys online ordering an MRI to look for a meniscus tear. If the MRI shows a meniscus tear, the patient and surgeon should Erwtensoep have a frank discussion of risks and benefits knee arthroscopy might offer. Unfortunately, just because your neighbor’s knee pain was better 2 days following arthroscopy does not mean that it will be true for you.