Does Meniscus Surgery Work? A Quartet of Studies Says It’s No Better than Fake Surgery or PT
Few patients ask the obvious question about knee meniscus surgery: Does meniscus surgery work? The answer, after many different high quality studies is that it definitely doesn’t work. Let me explain.
The first major paper on the efficacy of arthroscopic knee surgery was published more than a decade ago in 2002. It compared “arthroscopic debridement” (cleaning up an arthritic knee) with a sham surgery and the real surgery was found to be no better than fake surgery. This was a large study published in the New England Journal of Medicine. At the time, many surgeons stated that this study had nothing to do with the surgical treatment of meniscus tears or any knee surgery where the patient had no arthritis.
The next major blow to the concept of surgically treating knee meniscus tears came from the massive Framingham cohort of heart research fame. In 2008, this group looked at middle aged and elderly patients with meniscus tears and compared their pain levels and function. They curiously found no difference, meaning that patients with knee meniscus tears were just as likely to be asymptomatic as those without tears. Ouch! This obviously questions why we’re operating an any meniscus tear in the first place.
Last year the knee meniscus surgery empire took another body blow. A large study again published in the New England Journal showed that knee meniscus surgery patients didn’t do any better than those with physical therapy. Many surgeons who I spoke with still held onto the concept that there was value in operating on meniscus tears in patients without arthritis. Well that fantasy just got blown up this morning, when the New England Journal published a new controlled study showed that surgery for meniscus tears in these patients was no better than a fake surgery.
So let’s summarize:
1. Arthroscopic knee surgery to “clean up” an arthritic knee is no better than fake surgery
2. Knee meniscus tears in middle aged and elderly patients don’t cause pain or problems with function
3. Arthroscopic knee surgery doesn’t help middle aged patients with meniscus tears and mild to moderate arthritis any better than physical therapy
4. Arthroscopic knee surgery for patients with a degenerative tear and no arthritis doesn’t help patients any more than a fake surgery
What’s left to operate on based on the medical literature? Young patients with meniscus tears and no arthritis? Based on the literature showing that removing meniscus tissue can lead to more arthritis, I’ll tell my young patients with meniscus tears to avoid surgery at all costs!