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Et tu Shoulder Surgery?

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A recent publication by the Agency for Research and Quality that looked at conservative care vs. surgical repair for shoulder rotator cuff tears concluded that surgery provided no measurable benefit. This comes on the heels of other studies showing that orthopedic surgery for meniscus tears may have no benefit over physical therapy, 60% of knee surgery for ACL partial tears likely wasn’t needed, and knee surgery didn’t prevent the development of arthritis. Why all of these studies showing lack of efficacy for these surgeries on knees and shoulders?  Even arthroscopic surgery does a certain amount of damage to get the injured area into a state where it will heal.  In addition, removing parts of a joint (in a shoulder surgery often the end of the collar bone and the ligaments that help stabilize the front of the shoulder joint) can lead to more degeneration of the joint with time.  It’s a bit like repairing a car and having left over parts after the repair and then concluding that you didn’t need those extra parts in the first place.  All the parts are needed and we must be very careful about removing any of them (cutting ligaments, debriding cartilage out of the joint, removing pieces of labrum in a shoulder or meniscus in a knee).  The conclusion?  Orthopedic surgery is a God send for many trauma patients who need to be put back together and can help patients in select circumstances for common sports injuries, but the idea that routine surgery is needed for many problems like meniscus tears, joint arthritis, or torn ligaments, tendons, or muscles, doesn’t appear to be supported by the developing science.  We would advocate using injections in these circumstances (where appropriate and after physical therapy fails to solve the problem) to try to prompt the body to help heal itself.

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