One of the most common knee surgeries performed on patients today may be completely unnecessary in many instances, according to a recent study out of Finland. The study followed 146 patients between the ages of 35 and 65 with symptoms of degenerative wear and tear of their meniscus. The meniscus is a piece of disk-shaped cartilage between the shinbone and thighbone that functions like a shock absorber. None of the patients had detectable arthritis, pain caused by bone-on-bone rubbing, suggesting their pain was from their meniscus. Half of the patients underwent an arthroscopic meniscectomy where the surgeon uses a blade to shave off rough edges of the meniscus. The other half underwent a "sham" procedure where an incision was made but no other portion of the procedure was performed. A year later, there were no significant differences in knee pain reported by the patients. Nearly two-thirds of the patients were reportedly pleased with the outcome, including those who erroneously believed they underwent meniscus surgery.
For surgeons who have been keeping up with the literature, this recent studyd should not come as a complete surprise. According to studies conducted in 2002 and 2008, older patients who had frayed but not torn meniscus, and no specific injury, received little to no benefit from these surgeries. Dr. Teppo Jarvinen, who led the most recent study, puts it more bluntly: "All your fellow orthopedic surgeons will tell you, 'I already knew this.' But the facts are, this is still the most common orthopedic procedure" and the "vast majority of [these] operations are unnecessary."
Based on studies conducted over the last decade on meniscus procedures, surgeons who perform these procedures on patients with only a frayed meniscus, and no specific injury, may face a medical malpractice lawsuit. This is particularly true when the patient experiences a complication from the procedure, even if the complication occurred without malpractice. Indeed, if the procedure was unnecessary, any complication that follows, including those related to anesthesia, would not have occurred but for procedure.
Patients must be careful, however, not to draw too broad about all knee surgeries. For example, a frayed meniscus in an older patient, with no specific injury, is very different from a younger patient who suffers a complete tear during a sports injury. Likewise, knee pain from a meniscus injury is different from knee pain caused by arthritis due to bone-on-bone rubbing. Patients with the latter condition may benefit from a knee replacement if conservative treatment fails.
Patients experiencing knee pain should consult a qualified orthopedic surgeon to identify the cause of the pain and to discuss various options available to treat the pain. In many instances, physical therapy may be sufficient. If surgery is recommended, the patient should strongly consider obtaining a second opinion from another trusted orthopedic surgeon--particularly if the first surgeon is recommending meniscus surgery.
CNN, You May Not Be Better Off After Knee Surgery, December 26, 2013