The New England
Journal of Medicine recently published a Finnish
study that found arthroscopic surgery for degenerative meniscal
cartilage tears in the knee produced a similar result as a sham (fake) surgery.
With nearly 700,000 of these surgeries conducted each year
in the U.S., what does this mean for patients?
Dr.
Randall Schultz, orthopedic surgeon at Texas
Orthopedics, says that while the study is extremely enlightening, it doesn’t
entirely surprise him. And more studies need to be done before arriving to any
conclusions. “Additional research still needs to be done to change
recommendations across the board,” said Schultz. For instance, he says the
study didn’t specify the types of degenerative tears present—important
information for treatment recommendations.
“We’ve known for a long time that surgery isn’t needed for
all degenerative tears,” Schultz remarked. He explained
that many patients benefit from more conservative (non-surgical approaches)
before going under the knife, something he practices with his patients. “Generally we attempt weeks if not months of
conservative management prescribing physical therapy, anti-inflammatory
medications, activity modification and steroid injections before considering
surgery.”
However, Schultz also says that there are instances when
surgery is probably needed sooner – particularly if there is a mechanical
abnormality interfering with the motion of the knee.
Another reason Schultz believes patients ask for surgery is because
of a general misunderstanding of how meniscal tears are caused. “Many people
think that it happens because of something they did and that a surgery will
make it better. This is true in the younger population (under 30), but these
particular tears are more of a cumulative wear and tear issue…something that occurs
over time,” described Schultz. “What this study highlights is the natural progression
of these tears may be to get better in similar fashion as surgery. ”
‘The power of
placebo’ is interesting and future studies investigating their effect shouldn’t
be ignored. “We are in an era where you have to practice evidence based
medicine. It’s what’s best for the patient,” said Schultz.
A meniscus is a C-shaped pad of cartilage that cushions the
knee joint. For a meniscal repair surgery, orthopedic surgeons use a camera and
tiny instruments inserted through small incisions around the knee to shave away
damaged tissue. The process is called arthroscopy which is a minimally invasive
surgical procedure.
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