Anthroscopic knee surgery, one of the most common orthopedic procedures, may not be as effective as once hoped, according to research released by the New England Journal of Medicine.
In an unprecedented study, Finnish orthopaedic surgeon Raine Sihvonen and his colleagues fooled patients into believing they had undergone keyhole knee surgery. Because patients are typically awake during the surgery, Sihvonen's team anesthetized the patients, made the incisions, and inserted fluid and tools into the knee in a sham surgery, but did not manipulate the inside of the knee for repairs. The outpatient surgery usually involves locating tears in the meniscus using a camera inserted into the knee, and then trimming, moving, and reattaching the meniscus cartilage as necessary.
The control group received the typical arthroscopic surgery. Both groups were then tracked during the recovery, with no one but the surgical team knowing who had actually undergone the procedure. Astoundingly, at 12 months there was no significant difference between the control group and the group that had received fake surgery. Although the real surgery showed better improvement at 3 months, both groups recovered well and reported the same amount of pain and improved function of the knee at 12 months. Clearly, the placebo effect of the surgery played a factor.
Peter Choong, head of orthopaedics at St Vincent's hospital in Melbourne and professor of surgery at the University of Melbourne, gave COSMOS his opinion on the study. "The research is a valuable contribution. But what is not clear is whether a concerted physiotherapy program … would have drawn a difference," Choong said.
"It would also have been interesting to know if the consumption of over-the-counter painkillers was the same for the two groups in the short term." Choong added, "Unfortunately, we do not know the exact value for the effect of different factors responsible for the overall treatment effect with both groups." In other words, more research is needed to discover what benefits, if any, arthroscopic knee surgery offers patients, and how other therapies compare in the long run.
Sihvonen's researched used 160 adults aged between 35 and 65 diagnosed with meniscal degeneration and 76 received the shame surgery. The results of the study indicate that arthroscopic surgery may be unnecessary for common wear and tear, saving patients from the risks of anesthetic and a six month recovery. Keyhole arthroscopic knee surgery may still be beneficial for sports injuries such as the meniscus tear that NBA player Russell Westbrook suffered last year.
To learn more about meniscus tears, watch this video of anthroscopic knee surgery by Dr. David Oster of Denver-Vail Orthopedics.