Medial meniscus (knee cartilage) surgery no better than sham procedure in a small study

By ACSH Staff — Dec 30, 2013
A common knee cartilage operation is shown to be no better than a sham procedure: medial meniscectomy, repair or removal of a frayed or torn cartilage between the femur and tibia in the knee, had little effect on symptoms one year later.

knee-x-ray-2-391481-mA group of Finnish researchers studied symptomatic and functional results among 136 patients with evidence of medial meniscus symptoms and signs, by subjecting half of the group to a sham procedure arthroscopy without intervention as compared with the study group whose members got the actual operative repair intervention. The study patients were all free of osteoarthritis, the symptoms of which can be confused with disc (WHAT DISC??)disease. The report appeared in the latest New England Journal of Medicine.

This type of knee surgery is the most common orthopedic procedure performed in the U.S., done about 700,000 times at a cost of about $4 billion. One year after the surgery or sham, objectively recorded patient perceptions revealed no significant difference between the two groups: each on average felt quite well and would choose the same procedure again, even if they were told they had had the pretend one.

Of course, there are still some patients who definitely need the procedure (medically known as medial meniscectomy, removal or repair of a damaged cartilage on the inside of the knee joint). This rubbery structure is located between the thigh bone (femur) and the tibia two of the bones which make up the knee joint. An example: someone who injures the knee in a trauma such as a fall or accident may warrant intervention. Another obvious example would be the progressive deterioration that eventuates in a locked knee. Also, some patients whose pain and other symptoms are actually coming from some other damaged structure, including osteoarthritis, will of course not be helped by cartilage surgery.

ACSH s Dr. Gilbert Ross, a specialist in rheumatology, had this comment: This is quite surprising, as any athlete, especially those of us over the first flush of youth, know all too well: knee cartilage is highly vulnerable to the wear-and-tear of many enjoyable and beneficial athletic activities, especially running. Many of the over-40 crowd have experienced this arthroscopic, minimal intervention as a positive intrusion, allowing us or so we thought to resume activities after a suitable period of mourning for our lost cartilage, maybe 6 weeks or so. Now we learn, perhaps those weeks might have been better spent on physical therapy, and weight-loss! However, I would like to emphasize, this is a really small study; much more data on this topic are needed before committing to this outcome.

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