Osteoarthritis (OA) is extremely common in adults. According to the Arthritis Foundation, about 27 million people in the United States have osteoarthritis, the most commonly affected area being the knee. Many of those affected suffer from degenerative meniscal tears, which are sometimes treated with surgery. However, a new meta-analysis found that arthroscopic surgery for these tears was not associated with improvement in function of or pain in the knee.
Dr. Moin Khan of McMaster University in Hamilton, Ontario and colleagues conducted a systematic review of seven randomized trials including 805 subjects looking at arthroscopic surgery versus non-operative management in patients with mild knee OA. Mean age of the subjects was 56. Overall, researchers found no association between surgery and improvement in function or pain scores. Furthermore, the researchers found that surgery was not associated with any improvement in pain at six months following the surgery. The studies used the Knee Injury and Osteoarthritis Outcome Score an instrument assessing patients opinion about their knee that asks questions related to physical function and daily life, as well as sports and recreation to reach these conclusions.
According to the researchers, The results of this meta-analysis suggest that an initial trial of non-operative interventions should play a large role for middle-aged patients.
ACSH s Dr. Gilbert Ross had this comment: This meta-analysis clearly indicates that surgery should not be the first option for meniscal tears associated with knee OA. In fact, previous studies have found that weight loss is often an effective tool in helping to keep knee OA under control, as knee joint deterioration is well known to be accelerated by obesity. Therefore, a behavioral intervention should be considered first, depending on the patient. For more advanced OA, with life-altering pain or loss of function, the advances in total knee replacement surgery truly a miracle of modern medicine of only thirty-plus years existence is available to improve many OA patients lives.
ACSH s Dr. Josh Bloom adds, However, it should also be considered that arthroscopic surgery for a torn meniscus can still be necessary when the tear is severe enough that the torn piece can get caught in the knee joint, essentially locking up the knee. This can be very damaging if it is not dealt with, and patients should talk to their doctors about their options. And of course, acutely traumatized knees do need urgent intervention, notwithstanding this new study.