Greetings to you all!
Can't believe we are already well into August! Where does the time go? I hope your summer has been a great one! I decided this month to write on a topic that seems to be relevant for many of us!
Are you considered middle-age? Do you have knee pain? Have you been told you have a torn cartilage or meniscus? If so, you might want to read what the orthopedic surgery studies are now saying. As a 62 year old, with a torn meniscus and doing well without having surgery, I have had firsthand experience with what they are trying to tell us. As you read below, surgery is not your best option overall.
Dr. Jeffrey Katz, a professor of medicine and orthopedic surgery at Harvard Medical School believes that torn cartilage (or meniscus) surgery should not be offered to middle aged patients with knee pain, because he states "The surgery is a highly questionable practice without supporting evidence of even moderate quality evidence..." Dr. Katz also said that when they did MRI scans on knees of middle aged people, they often saw cartilage (meniscus) tears in people who had no pain. In these cases the cause may be osteoarthritis.
This knowledge is known in the orthopedic world and still there are about 400,000 middle-aged and older Americans a year, having meniscus or torn cartilage surgery. The surgery offered little relief to most who had it. Other studies came to the same conclusion and so did a
meta-analysis
published last year of nine clinical trials testing the surgery. Patients tended to report less pain - but patients reported less pain no matter what the treatment, even fake surgery.
Then came
another study
, published on July 20 in The British Medical Journal. It compared the operation to exercise in patients who did not have osteoarthritis but had knee pain and meniscus tears. Once again, the surgery offered no additional benefit.
So what should patients be told? Should they even be offered the surgery?
"Patients should be told that physical therapy is a good first-line therapy for pain relief", Dr
. Katz said "but that surgery also relieves pain. Pain relief can take longer with physical therapy and with surgery patients have to recover from the operation but are likely to be back at work within two weeks."
"At the end of the day," he said, "patients ought to choose."
Of course, how they choose might depend on how the choice is presented.
Here's how Dr. Gordon H. Guyatt, a professor of medicine and epidemiology at McMaster University in Hamilton Ontario, who wrote the editorial in The British Medical Journal, would deal with the clinical trial data:
"I personally think the operation should not be mentioned," he says, adding that in his opinion the studies indicate the pain relief after surgery is a placebo effect. But if a doctor says anything, Dr. Guyatt suggests saying this: "We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense and potential complications."
Hearing that, he says, "I cannot imagine that anybody would say, 'Go ahead. I will go for it.'"
I wonder if you are as surprised with these studies, performed by the orthopedic surgery community, as I am. People often tell me that I am pushing exercise because it is my profession. It is true that I am a big physical therapy fanatic but I also do not hesitate to refer my patients to an orthopedic surgeon when warranted. Now it looks like the orthopedic surgery world is warranting physical therapy and that brings a smile to my face!
If you have knee pain, please call and let us examine your knee and direct you to the proper type of care that will help you regain your strength and pain free function. We truly think we can make a big difference!
