Knee arthroscopy not all it’s cracked up to be

physio or chiropractic for PFS in BrightonMany people with recurrent knee pain have keyhole surgery to trim the cartilage in the knee. Recent research suggests that this operation – an arthroscopy, is no better than doing exercises. This surgery is one of the most common in the UK. About 150,000 people, mainly middle aged and older adults undergo this procedure every year so you would think there is good evidence to show that it works.

Over the last 10 years several studies have looked at the effectiveness of knee arthroscopy. This includes studies that group together all these results in a so called meta-analysis. In science terms, this is a good as it gets – gold standard evidence one way or the other. It showed no benefit for keyhole surgery for the knee. Keen to sew this up once and for all this new study compared two groups.

A Norwegian team looked at people with knee pain with a tear of the cartilage (meniscus) which had been verified on MRI. The patients did not have any evidence of osteoarthritis. They divided these 140 patients into two groups – one group had the surgery and the other a 12 week course of exercises. The exercise group did a series of knee exercises two or three times a week.

The patients in the exercise group had improved muscle strength in the thighs and reported less pain, swelling and restricted joint movement. This is not surprising as surgery can cause these symptoms. Both groups reported similar improvements to the surgery group patients when asked about daily activities. Nearly a quarter from both groups went on to have further knee symptoms of pain, swelling and dysfunction.

If you have knee pain and have a suspected tear to the meniscus this study suggests that a course of supervised exercises would be well worth a go. The surgery for this condition is no better and may well be worse – especially in the short term. Given that surgery  carries a risk it merely highlights the benefits and safety of exercises.

If you have knee pain and want to have the best evidence based care then book an appointment with our physio.

Reference: BMJ 2016;354:i3934


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