Knee surgery for torn cartilage may not be worthwhile

(Reuters Health) – Many middle-aged and older adults with torn cartilage and pain in their knee are not likely to benefit from so-called arthroscopic surgery, a review of past studies suggests.

Researchers analyzed 10 previous clinical trials that randomly offered some patients knee surgery and others nonsurgical options including exercise or medication. Overall, knee surgery was no better than these alternatives for improving physical function, and resulted in only a small reduction in pain.

However, when researchers looked just at a subset of patients without knee pain from arthritis in their knee, surgery did appear moderately better than physical therapy for reducing pain from the tear.

“Surgery does not work for everyone but in selected cases we show that surgery should be available to patients,” said lead study author Simon Abram of the University of Oxford in the UK.

“In most circumstances, patients should try physiotherapy first,” Abram said by email. “If this does not improve symptoms, knee surgery may be beneficial, especially in patients without osteoarthritis and with specific symptoms.”

Worldwide, more than 4 million people get arthroscopic knee surgery each year, according to the American Orthopedic Society for Sports Medicine.

During the operation, a surgeon makes a small incision in the knee and inserts a tiny camera called an arthroscope to view the inside of the joint, locate and diagnose the problem, and guide repairs. Sometimes surgeons remove all of the meniscus, the cartilage that works as a cushion between the shin and thigh bones, and other times they only remove part of it.

While this is minimally invasive, it’s not risk-free. Patients receive anesthesia, which in any surgery may lead to complications such as allergic reactions or breathing difficulties. In addition, this specific procedure might potentially damage the knee or trigger blood clots in the leg.

In the current analysis, all of the trial participants who got knee operations had a partial meniscectomy, removing only some of this cartilage.

For all types of patients – including people with and without arthritis pain – surgery was slightly better than physical therapy at reducing pain after 6 to 12 months, an analysis of five trials with a total of 943 patients found.

In three trials of 402 patients without arthritis pain, surgery had a small to moderate advantage in knee pain improvement after 6 to 12 months over physical therapy.

Two trials with 244 patients without arthritis pain also found surgery associated with a moderate to much larger improvement in quality of life than nonsurgical treatment.

One limitation of the analysis is that none of the smaller trials had long-term outcomes, researchers note. Another drawback is that pain and quality of life assessments in the smaller studies may have been of poor quality or incomplete in some instances.

The analysis also focused on patients in their 40s and 50s, and may not reflect what would happen with younger adults, said Dr. Jonas Bloch Thorlund, a sports medicine researcher at the University of Southern Denmark in Odense who wasn’t involved in the study.

“The effect of meniscal surgery for younger populations 18-40 years has never been compared with non-surgical treatments (exercise therapy or placebo),” Thorlund said by email. “The best treatment – surgical or non-surgical – remains to be established in this younger patient group.”

Even so, the results may help doctors better determine which older patients might benefit from knee surgery, said Dr. Kyle Hammond of the Emory University Sports Medicine Center in Atlanta.

“Patients who benefit from meniscal surgery, tend to have minimal arthritis and/or a displaced meniscal tear, like a ‘hang-nail’ that is causing them discrete mechanical symptoms (catching or locking sensations in the knee joint) with provocative actions both in life activities, (and) also during the physician’s physical exam,” Hammond, who wasn’t involved in the study, said by email.

“The . . . patient may not benefit from arthroscopy when the patient’s knee pain is more consistent with kneecap pain sources and/or other arthritic pain sources,” Hammond added. “In these instances, the physician should consider a non-surgical approach, such as physical therapy, a knee injection and/or an anti-inflammatory program.”

SOURCE: bit.ly/2IY4pmW British Journal of Sports Medicine, online February 22, 2019.

This story adds dropped word “of” in paragraph 10

Source

more recommended stories

  • FDA finds ‘significant violations’ at India’s Strides plant

    (Reuters) – The U.S. Food and.

  • U.N. wants more urgency in AIDS fight as gains and funding fade

    LONDON (Reuters) – The global fight.

  • Oklahoma seeks to hold J&J responsible for opioid crisis as trial ends

    NORMAN, Okla. (Reuters) – Lawyers for.

  • Healthy living may help offset genetic risk of dementia: study

    LONDON (Reuters) – Living healthily with.

  • Democrats take aim as Trump abandons drug pricing plan

    WASHINGTON (Reuters) – Democrats see U.S..

  • U.S. appeals court blocks Trump administration birth control exemptions

    (Reuters) – A federal appeals court.

  • China vows to tackle dead pig scam amid swine fever epidemic

    FILE PHOTO: Piglets are seen by.

  • Alberta joins Ontario in pulling some CannTrust weed products

    TORONTO (Reuters) – Alberta is placing.

  • Trump administration pushes U.S. at-home kidney care, transplant availability

    NEW YORK/WASHINGTON (Reuters) – The Trump.

  • U.S. appeals court signals sympathy to bid to strike down Obamacare

    NEW ORLEANS (Reuters) – A federal.

  • U.S. judge strikes down Trump administration rule requiring drug prices in TV ads

    (Reuters) – A federal judge on.

  • Intra-Cellular drug fails one of two bipolar depression studies; shares fall

    (Reuters) – Intra-Cellular Therapies Inc said.

  • China reports new African swine fever outbreak in Guangxi region

    BEIJING (Reuters) – China’s southwestern region.

  • Weed ban means no Rocky Mountain high for Canada’s Calgary Stampede

    CALGARY, Alberta (Reuters) – Canada’s Calgary.

  • Weightlifting better at reducing heart fat than aerobic exercise

    Obese people who engaged in resistance.

  • Sydney’s city council reviews use of Bayer’s Roundup weed killer amid cancer fears

    SYDNEY (Reuters) – Sydney’s city council.

  • Bulgaria confirms two cases of African swine fever

    SOFIA (Reuters) – Bulgaria has confirmed.

  • FDA approves Karyopharm Therapeutics’ blood cancer drug

    (Reuters) – The U.S. Food and.

  • Facebook to tackle content with misleading health claims

    FILE PHOTO: The Facebook logo is.

  • FDA ties three deaths to Edwards Lifesciences’ recalled heart devices

    (Reuters) – The U.S. Food and.

  • India asks its states not to partner with Philip Morris-funded foundation

    NEW DELHI (Reuters) – India’s health.

  • U.S. federal court delays adoption of healthcare rule on abortion

    FILE PHOTO – A imaging table.

  • China tightens vaccine management after scandals

    FILE PHOTO – A nurse prepares.

  • U.S wages lost to unpaid family care to hit $147 billion by 2050

    As the U.S. population ages, the.

  • U.S. ‘gag rule’ linked to 40% jump in abortions in parts of Africa

    LONDON (Reuters) – A decades-old U.S..

  • Study shows major real-world impact of cervical cancer vaccines

    LONDON, June 26 (Reuters) – Vaccination.

  • Glyphosate use will eventually end, Merkel says

    German Chancellor Angela Merkel attends a.

  • Unproven stem cell therapies often peddled by doctors without training

    At U.S. clinics advertising unproven stem.

  • Teleflex recalls breathing tubes worldwide after reports of 4 deaths

    (Reuters) – Teleflex Inc said on.

  • In border camps, Syrians rely on doctors in trucks and tents

    AZAZ, Syria (Reuters) – The Syrian.

  • Thailand bans pig imports from Laos after African swine fever outbreak

    BANGKOK (Reuters) – Thailand will ban.

  • FDA approves drug for loss of sexual desire in women

    (Reuters) – The U.S. drug regulator.