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Arthroscopic knee surgery offers no lasting pain benefit

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Why is arthroscopy still so common?

While randomized trials, uncontrolled observational studies, and surgeons’ own observations suggest that patients improve after arthroscopy, robust and bias-free trials that use placebo controls show that active treatment works no better than control treatment.

We may be close to a tipping point where the weight of evidence against arthroscopic knee surgery for pain is enough to overcome concerns about the quality of the studies, confirmation bias, and vested interests. When that point is reached, we should anticipate a swift reversal of established practice.

Dr. Andy Carr is from the Oxford University Institute of Musculoskeletal Sciences at the NIHR Oxford Musculoskeletal Biomedical Research Unit, Oxford, England. These comments are taken from an accompanying editorial (BMJ 2015, June 16 [doi:10.1136/bmj.h2983]). He declared research grants from NIHR and Arthritis Research UK.


 

FROM BMJ

References

Arthroscopic knee surgery in middle-aged or older patients with knee pain is associated with greater harm than good, according to a meta-analysis.

The analysis of nine randomized, controlled trials in 1,270 patients of arthroscopic surgery involving partial meniscectomy, debridement, or both showed a small but statistically significant benefit from the procedure – comparable to the pain-relieving effects of paracetamol – but which falls below significance after 12 months.

However, there were no significant improvements in knee function, and there were significant increases in the risk of deep vein thrombosis (4.13 events per 1,000 procedures) as well as infection, pulmonary embolism, and death, according to the paper published online June 16 in BMJ.

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“Thus, middle-aged patients with knee pain and meniscal tears should be considered as having early-stage osteoarthritis and be treated according to clinical guidelines for knee osteoarthritis, starting with information, exercise, and often weight loss,” wrote Dr. Jonas B. Thorlund of the University of Southern Denmark, Odense, and coauthors (BMJ 2015, June 16 [doi:10.1136/bmj.h2747]).

The study was supported by the Swedish Research Council. One author declared personal fees from several pharmaceutical and medical companies and relevant journal editorship, while another declared fees from lectureships and books.

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