I was recently being diagnosed with a torn meniscus from playing football. Thus, I’ve been looking up a lot of research on various knee surgeries lately.
I have a good base of knowledge but I find I tend to go through phases where a specific condition or joint tends to predominate in my life or in my clients. That leads me to see what new things I can learn related to that condition or joint.
While researching different forms of knee surgery I came across this AWESOME paper on arthroscopic surgery on the knee for people with osteoarthritis.
Without going into too much detail in this post, I’ve always been (very) skeptical of the majority of knee surgeries done on people. Specifically arthroscopic surgery for “cleaning” out the knee. This would consist of cleaning up the meniscus, bone spurs, etc. This is a big part of what’s done in knee surgery for arthritis.
The first reason for this is there are a lot of people walking around with a beat-up meniscus who aren’t in any pain. This review paper cites a study showing that 59% of basketball players and endurance runners (people who beat the hell out of their knees) have a full thickness chondral defect in at least one of their knees, yet they aren’t in any pain! (Shout-out to Eric Cressey for posting that research.)
In simpler terms: there are studies showing the majority of certain athletes aren’t in pain yet still have a full tear of their cartilage.
Furthermore, there are plenty of people who are in constant knee pain yet will have no abnormal findings, such as a meniscal tear, show up on a MRI.
Ironically, in my own experience, from the time I was 17 til I was about 19, I was in near constant knee pain. It was never excruciating but it was there. During that time period I had a MRI done which came back flawless. Fast-forward to now and I have a torn meniscus (verified by MRI) and barely have any knee pain.
The second reason I’m not a big fan is based on the amount of people I have talked to and seen post-surgery: it seems to almost be a toss-up as to whether or not the surgery gives them any pain relief.
One thing I have seen a few times is those who are religious about their post-op rehabilitation report better results than those who are not. Again, this is simply anecdotal and I don’t have data to back this up. Just what I’ve noticed.
Going along with the above though, perhaps it’s not the surgery that gives the person relief but it’s the strict adherence to their physical therapy that does. Again, so many have surgery and feel the same afterwards it’s hard to say the surgery did anything positive for them.
At the same time, there are a lot of people who get no relief from physical therapy either. Maybe the people post-surgery are much more adherent to their therapy than before the surgery though, and that’s why they’re now getting relief? Maybe it was just a poor physical therapy program to begin with? Hard to say.
And that brings us to this ridiculously awesome paper I found:
–A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee
Here’s a quick rundown of this study: They took two groups of people. One group would have surgery designed to clean up the knee with arthroscopic surgery. The other would have placebo surgery.
You know how drug studies give one group the actual drug and another group a sugar pill, yet the group who took the sugar pill will report effects similar to the drug group? These researchers wanted to see if the same thing would happen, but with surgery.
So both groups knew they were going to have surgery, but one group went through all the actual prep and action of surgery without anything specifically done to help the knee.
Yet this group, who was checked on intermittently for TWO YEARS, reported the same results as the group who actually had surgery!
Click to make the images bigger:
The lavage and debridement group are similar for the purpose of this post i.e. they both had actual knee surgery designed to clean up the knee and alleviate arthritis. Minimal improvements in the amount of pain post-surgery are seen here
Improvement in the function of the knee in ALL groups can be seen here
For anyone who is considering, or might ever have to consider having surgery to help alleviate pain associated with arthritis of their knee(s), this study should really make you stop and think. Based on this paper, and my own experience as well, chances are you’re going to have minimal, if any improvement in your pain. Yet you’ll still have to deal with all the issues that come along with having to go through surgery.
From the paper:
“If the efficacy of arthroscopic lavage or débridement in patients with osteoarthritis of the knee is no greater than that of placebo surgery, the billions of dollars spent on such procedures annually might be put to better use.”
Unfortunately, this doesn’t seem to have remotely happened. If anything, we are even more prone to cutting people open despite the lack of evidence for doing so.
One negative about this paper is the fact the sampling for the study was done about 15 years ago. The advances in technology and surgical techniques could possibly change the results of this study if it were done now. Based on the experiences I’ve had with people who’ve recently had surgery akin to the surgeries done in this paper, I highly doubt it.
So it would appear that “fixing” or “cleaning” out the knee doesn’t do much for pain relief or the function of an arthritic knee. The issue here is not that when looking at a MRI the inside of the knee looks all chewed up. The issue is figuring out what caused the knee to become all chewed up to begin with. And no, “age” does not qualify as a sole cause.
Other charts from the paper illustrating the results:
Eileen Gavin Kelly
August 22, 2011
Hi Brian, read your article —- does it compare with hip surgery? Alas, I had horrific pain in my hip and an xray, ct scan and MRI showed absolutely nothing and I finally found a doctor who gave me a prescription for “Mobic” (generic drug name) and I am a new person with no pain at all “A Miracle!” so I say. The first doctor I went to wanted to do hip surgery. I was told I had osteoarthritis – but no more!!!!! Pain is gone….
reddyb
August 23, 2011
I haven’t come across any studies like the above that have been on the hip, I haven’t really looked either though, so I can’t really say for sure. I wouldn’t be surprised if results were similar though.
What I mentioned above applies to the hip as well: Just because there are abnormal findings on imaging doesn’t mean getting rid of those abnormal findings will get rid of the person’s pain. You need to get rid of whatever is causing the abnormal findings to happen.
That’s very surprising to me the doctor wanted to do hip surgery without seeing anything noticeable on an XRay, CT, or MRI, how did he even come to the conclusion of arthritis? Do you know what type of hip surgery he wanted to perform?
Eileen Gavin Kelly
August 23, 2011
have no clue as to the kind of hip surgery cause I did not want to go that route no matter what! I have no pain since taking the meds….I gotta start investigating what the medicine is long term….Nanny Bea and Aunt Bea both had hip replacements and neither one walked that great after and then the other hip went due to favoring one over the other. So that is why I didnt want to have any surgery!!!! any way for now I feel great!!!!
reddyb
August 23, 2011
Yeah, unfortunately I’ve seen similar things in many other people. The mentality of just have surgery and I’ll be fine rarely works. A lot of things can come up afterwards.
Keep me posted on how things go.
Greg Minor
August 27, 2011
I have arthritis in my knee FROM knee surgery. Without going into details of the three times I was opened up, the point I want to make is my pain is manageable as long as I keep moving. For me the pain is worse on days I have to stand staionary for any length of time and best after I have ridden my bike for a fair amount of time. The day after a rest day my pain is worse. I would not have another surgery unless I absolutely could not move. I have talked with lots of people with joint replacments and the results seem to be about 50/50 except hip replacements which seem to go pretty well for most of the people I have known who had them. The key for all is a diligent recovery therapy and to continue lifestyle that incoperates the therapy exercises.I would always try the therapy first and the surgery as a last resort.
reddyb
August 28, 2011
Thanks for the great insight Greg. My experience has been very similar.
Aileen
April 19, 2014
Hi Brian, I was reading your latest article regarding the body protecting itself and followed the link to this page. I have already written to you on my hip issue, which has improved greatly thank you.
Regarding knee surgery…I fell on my knee around thirty years ago due to my German shepherd pulling me over. (Instability!!).Around twenty five years ago, I had a lateral dislocation of the patella, same knee, playing sport (instability). I was put in plaster for 6 weeks with no physiotherapy offered and then around ten years ago my same knee started locking at the most inconvenient times while training (instability) to the point I had to hang from a high bar (if there was one available)to unlock it).
My first surgeon looking at my MRI and my age, I believe and said I would need a scrape and eventually a full knee replacement. He sent me to a physiotherapist while i waited for surgery. The physiotherapist suggested I see another surgeon for a second opinion. This second surgeon said he thought the tear needed trimming to stop it catching and locking. I underwent surgery for the tear and its been great since.
Do you agree the torn part of the meniscus required to be removed to stop my knee from locking or would it have corrected itself in time? I was worried that it would lock while driving etc. Later down the line I recently have hip problems on the other side (anterior femoral glide).
All these issues are I am sure due to bad movement…..had you been around thirty years ago along with the internet…I might have been able to solve my problems quicker.
Love to hear your thoughts on surgery for the locking problem.
reddyb
April 20, 2014
Hey Aileen,
In a post about partial menisectomy surgery ( http://b-reddy.org/2014/03/05/more-evidence-against-knee-surgery/ ) I wrote:
The reason I left that 1% possibility in there is because of what you’re referencing. Based on the research, such as that study, the answer to the question “Would you be just as well off without the surgery?” is a firm yes. I went over mechanical symptoms in that post, and the study explicitly goes over this aspect as well. However, based on my experience with people, I just can’t come to saying no one needs surgical assistance.
So, your question of “Would it correct itself” is kind of up in the air. “Would you have the same function, same symptoms, same satisfaction without surgery?” A strong likelihood. Can you say this is guaranteed? I don’t believe so. This is strictly a gut feeling. I don’t have any statistics supporting this.
With that, it’s worth mentioning the meniscal tear won’t “correct itself” per se. It’s not going to heal or anything. (It could, but this is very unlikely.) However, it’s plausible the tear will eventually break off by itself, degrade to the point it’s not a factor, or something of this sort. So that, with time, the same effect of surgery happens: The tear is made to not influence things. That is, whether it’s cut off with a knife or breaks off spontaneously, the result -in the long term- of having surgery or not having surgery, is the same.
Aileen
April 20, 2014
Thank you, I wasn’t told that it could break off itself so I opted for surgery when it was offered. I can’t believe the amount of people I know, who have had knee surgery and are still in pain years later…unable to get on and of the floor….can’t walk very far, can’t get out of chairs etc etc. Maybe it is because they are in my own age group 50/60/70’s that I am meeting so many knee problems post surgery and the patients who claim they are no better off than before. I teach Pilates based group exercise classes and have to refer so many clients back to their physiotherapists, due to the problem s of not being able to move safely as I mentioned earlier.
reddyb
April 21, 2014
It’s unfortunately true. And then the quality and quantity of physical therapy care they receive is completely up in the air. I know people who had major reconstructive knee surgery, a procedure requiring a minimum of 6 months of physical therapy, who were given only 4 therapy sessions!
There is the other side of this as well: Too many patients expect to have a surgery and magically have great function. For the surgeries that actually do offer a benefit, even then an extensive exercise process needs to take place post surgery.
I joke with my older clients all the time about how getting older is work. Just like if you want to make a living, you have to work at it. If you want to keep on living, you have to work at it. At least if you don’t want to be perpetually disabled!
Aileen
April 21, 2014
Yes, I agree totally…we have a responsibility to each other to look after ourselves otherwise young people like you will be left to look after those who didn’t look after themselves rather than caring for those who are unfortunate and have disease and trauma. One of my clients is a nurse in her sixties and she is fed up hurting herself, trying to move people who are obese and won’t help themselves. I have an older client who is very fit and puts in a lot of effort into keeping healthy. He reckons people in his age group who can’t move due neglecting themselves should be put down!! A bit over the top, but you can see how some people get fed up with their peers who do little to help themselves. Have a great day.
Chloe
September 6, 2017
Are there any current postings since 2014? I have a torn meniscus and arthritis and have questions and the Ortho wants to due surgery. Not sure
b-reddy
September 9, 2017
Hey Chloe,
Knee postings: https://b-reddy.org/category/pain-2/knee-pain-pain/
Meniscus postings: https://b-reddy.org/category/meniscus-repair/