How Effective is Arthroscopic Knee Surgery?

For patients with osteoarthritis, the answer is not at all.

A paper in the New England Journal of Medicine examined 180 patients 75 years old or younger, that had osteoarthritis of the knee, and reported at least moderate knee pain on average despite medical treatment.  The researchers randomized this individuals into three groups:

• Surgery Group #1 (Lavage): The joint was lavaged with at least 10 liters of fluid. Anything that could be flushed out through arthroscopic cannulas was removed. Normally, no instruments were used to mechanically débride or remove tissue.
• Surgery Group #2 (Débridement): The joint was lavaged with at least 10 liters of fluid, rough articular cartilage was shaved (chondroplasty was performed), loose debris was removed, all torn or degenerated meniscal fragments were trimmed, and the remaining meniscus was smoothed to a firm and stable rim.through arthroscopic cannulas was removed. Normally, no instruments were used to mechanically débride or remove tissue.
• Placebo Procedure: To preserve blinding in the event that patients in the placebo group did not have total amnesia, a standard arthroscopic débridement procedure was simulated. After the knee was prepped and draped, three 1-cm incisions were made in the skin. The surgeon asked for all instruments and manipulated the knee as if arthroscopy were being performed. Saline was splashed to simulate the sounds of lavage.

The authors compared patient pain levels in these three groups before the surgery and after the surgery at regular increments (2 weeks,  6 weeks, 3 months, 6 months, 1 year and 2 years.)    The authors found that “At no point did either arthroscopic-intervention group have greater pain relief than the placebo group.”

Source:

• Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002 Jul 11;347(2):81-8.