This is a frequent occurrence in any clinic treating patients with knee pain:
A middle aged patient develops pain in a knee. Patient goes to an orthopedic surgeon who orders an MRI scan of that knee. MRI scan gets done and it shows a tear in a meniscus. (The meniscus is a C-shaped piece of cartilage located inside the knee joint. It serves as a shock-absorption system, assists in lubricating the knee joint, and limits the ability to flex and extend the joint.) Orthopedic surgeon takes a look at the MRI and goes: “Aha, there it is, the source of your pain”, and recommends an arthroscopic “meniscus repair” surgery. Surgery is performed, pain is relieved for a short time and eventually comes back. This is, indeed, a very common scenario. Arthroscopic knee surgeries are the most common surgical procedure performed by orthopedic surgeons in the USA. Hundreds of thousands of these surgeries are performed every year.
There are several things wrong with this common scenario, starting with the fact that the presence of meniscal tears on a MRI scan has little correlation with knee pain. Several published studies have shown that a meniscus tear is a common incidental finding that becomes more common as we age. This study showed that, in the general population, among men over the age of 70, more than half have meniscal tears on their knees, regardless of whether they have knee pain or not.
Another problem with this scenario is that knee arthroscopic surgery very rarely involves any actual “repair” of a meniscus. Almost always this surgery involves simply a resection of the part of the meniscus that is torn (See here). Unfortunately, once a piece of a meniscus is removed, the meniscus cannot properly perform its function, which is to protect another type of cartilage, articular cartilage, which lines the bones of the joint. Loss of articular cartilage is what happens with osteoarthritis of the knee. It has been shown (look here ) that having this procedure, called a meniscectomy, done predisposes you to more arthritis of the knee.
Furthermore, knee arthroscopic surgeries are not particularly effective. Several studies (example 1, example 2) have shown that this type of surgery is not better than conservative care for the treatment of degenerative meniscus tears. If that wasn’t enough another recent study, published by the prestigious British Journal of Medicine, painted a very negative picture of the use of knee arthroscopic surgeries. This was a review of 9 clinical trials of knee arthroscopic surgeries in middle aged and elderly patients. This review found that surgery had a small, inconsequential benefit, and that this benefit was smaller than the one seen with exercise therapy for knee osteoarthritis. Additionaly, this surgery was associated with significant risks, like: infection, deep venous thrombosis, pulmonary embolism, and death. The authors of this study concluded that “ These findings do not support the practice of arthroscopic surgery as treatment for middle aged or older patients with knee pain with or without signs of osteoarthritis.”
- A meniscal tear on an MRI is an incidental finding, common as we age, and not necessarily indicates the source of your knee pain.
- Arthroscopic meniscal surgeries do not repair the meniscus, just removes portion of it.
- Removal of the meniscus predisposes the knee to osteoarthritis and future knee replacement surgeries.
- Arthroscopic meniscal surgeries have no better outcomes than non-surgical treatments, but, si more risks and complications.
All of this points to a very clear equation:
Knee pain + meniscus tear on MRI + surgery = trouble
So, why are so many of these unnecessary surgeries performed every year? Your guess is as good as mine. The important thing to remember here is that when it comes to a meniscus tear, a surgery is probably not your best option. Fortunately, now Regenerative Medicine and stem cell therapy offers a viable alternative to treat joint pain from arthritis without the risks of surgery. Your own cell can be used to decrease the chronic inflammation that causes much of the damage in osteoarthritis, and to regenerate the joint cartilage.
To learn more about non-surgical alternatives to joint arthritis pain go to: www.dontoperate.com .