A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports.
The study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees. Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed, the study said, about 700,000 times a year at an estimated cost of $4 billion.
The study, conducted in Finland, involved a small subset of meniscal tears. Experts, including some orthopedic surgeons, said the study added to other recent research, suggesting that meniscal surgery should be aimed at a narrower group of patients and that, for many, options like physical therapy may be just as good.
The surgery, arthroscopic partial meniscectomy, involves small incisions. They are to accommodate the arthroscope, which allows doctors to see inside, and the tools used to trim torn meniscus and to smooth ragged edges of what remains.
The Finnish study does not indicate surgery never helps; there is consensus it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries.
But, about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.
The volunteer patients in the Finnish study all received anesthesia and incisions.
While some received actual surgery, others got simulated procedures; the volunteers did not know which.
A year later, most patients in both groups said their knees felt better, and the vast majority said they would choose the same method again, even if it was fake.
“It’s a well-done study,” said Dr. David Jevsevar, chairman of the committee on evidence-based quality and value of the American Academy of Orthopaedic Surgeons. “It gives further credence or support to a number of studies that have shown that giving arthroscopy to patients is not always going to make a difference.”
Jevsevar, an orthopedic surgeon in St. George, Utah, said he hoped the study would spur research to better identify patients who should have surgery.
