Thousands of Americans who undergo a common knee surgery might be making their problems worse rather than better.
Researchers who followed patients for 10 years after they received either the actual procedure, arthroscopic knee surgery to trim degenerative cartilage tears, or merely “sham surgery” — a skin incision — for knee pain, found that the surgery provided little or no benefit and was, in fact, associated with accelerated osteoarthritis and higher rates of reoperation.
The study’s findings have significant implications for the treatment of knee pain, particularly for middle-aged or older patients with cartilage tears, which often require a thorough evaluation to determine the best course of action.
“I don’t know how I would defend this procedure at all,” said one of the study’s authors, Teppo Järvinen, an orthopedist and the head of the Finnish Centre for Evidence-Based Orthopaedics.
Järvinen stated that patients who have this procedure have more pain — they do worse, as all the scores pointed in the same direction.
The study, published in April in the New England Journal of Medicine, was the first to show the surgery left many patients worse off.
Though the study was small, the results were compelling, Järvinen said, because his team picked the patients “most likely to benefit.”
The study does not apply to cartilage tears incurred from an acute pain-causing injury.
It included subjects middle-aged or older who were experiencing knee pain and whose MRIs showed cartilage tears.
Evidence has been accumulating steadily for over a decade that arthroscopic knee surgery to shave torn, degenerative cartilage does not help more than physical therapy.
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Arthroscopic rates in Finland have dropped 90%, Järvinen said.
They have been falling in the U.S., too, but at a far slower rate.
One study of commercial claims in the U.S., which counted over 2 million meniscus surgeries from 2010 to 2020, found the number decreased by about 4% each year.
Most procedures were performed on women and patients in their 50s.
In the traditional Medicare fee-for-service program, the number of procedures has declined steadily in recent years, from about 169,000 in 2014 to 91,000 in 2024, federal data shows.
For patients with knee pain, the decision to undergo arthroscopic knee surgery can be complex.
The potential benefits and risks must be carefully weighed.
In practice, this means that patients should be fully informed about the available treatment options, including physical therapy and other non-surgical approaches.
Prior studies of scans have found that such tears are common in people over 50, the result of wear and tear and often not painful.
“Nothing supports the idea that a patient’s pain comes from the meniscus,” Järvinen said.
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Robert Brophy, director of the Orthopaedic Clinical Research Center at Washington University in St. Louis, said that “evidence is growing for judicious use of this surgery in this population.”
But, he noted, “many patients do benefit.”
A concerted campaign by orthopedic specialty societies called the Save the Meniscus Society has been ongoing for years.
The group advocates for protecting and maintaining long-term knee health through nonsurgical treatments, surgical repair, and other therapies.
Treating chronic knee pain has a variegated history.
Fifty years ago, the treatment for cartilage tears, from acute injury or from wear and tear, was to remove the entire piece of cartilage.
Today, the first-line therapy for a painful knee with degenerative tears is physical therapy and, for some people, weight loss.
Then there is arthroscopic surgery, depending on the view of the surgeon about its utility.
There is also a menu of injections: Steroids have proved scientifically valuable in the short term.
