Experts advise against surgery for degenerative knee damage
Knee arthroscopy (keyhole surgery to relieve pain and improve movement) should not be performed in almost all patients with degenerative knee disease.
A panel of international experts strongly recommended in The BMJ, against surgery based on new evidence that it does not, on average, result in a lasting improvement in pain or function - and they say further research is unlikely to alter this advice.
Every year, an estimated two million people worldwide undergo knee arthroscopy at a cost of $3bn per year in the US alone. Yet current evidence suggests that arthroscopic knee surgery offers little benefit for most patients and is not cost effective.
Yet, despite there being no evidence that arthroscopy is beneficial in any patient group, most guidelines continue to support the use of arthroscopy in key subgroups, including those with meniscus tear, sudden onset of symptoms (such as pain or swelling), or mild-moderate difficulties with knee movement. Most people with degenerative knee disease fit into at least one of these subgroups.
An international panel - made up of bone surgeons, physiotherapists, clinicians and patients with experience of degenerative knee disease (including those who had undergone and those who had not undergone arthroscopy) decided to carry out a detailed analysis of the latest evidence.
Their rapid recommendation package includes a systematic review (published in BMJ Open) which adds the 2016 trial to the existing body of evidence, and a review of patients' preferences on knee disease (also published in BMJ Open). These data were used as the basis for the recommendation.
Using the GRADE approach (a system used to assess the quality of evidence), they found that arthroscopic knee surgery does not, on average, result in an improvement in long term pain or function to all or almost all patients with degenerative knee disease.
As such, they strongly recommend against arthroscopy for almost all patients with degenerative knee disease - and suggest that non-use of knee arthroscopy can be used as a performance measure or tied to health funding.
See also other related BMJ Open research:
12 May 2017.