A recent article in The New England Journal of Medicine called knee arthroscopy “needless surgery”. This report is, by no means, the whole story, and; in fact, will keep many patients from getting this helpful procedure. A candidate for arthroscopic surgery is a patient with acute injury with a meniscal cartilage tear or a patient with a chronic meniscal tear who has failed conservative treatment of greater than six weeks. Patients younger than age 50 are treated more aggressively, and patients older than 50 years old are treated more conservatively. Conservative treatment includes nonsteroidal anti-inflammatory medication, physical therapy, and cortisone injection. Other criteria include level of pain, amount of disability, and inability to perform activities of daily living and sporting endeavors. The patient and physician together review all these variables and formulate an individualized treatment plan for recovery. Each patient’s treatment plan is modified to relieve their painful symptoms. The patient must trust the experience and expertise of the orthopaedic surgeon to see if they are candidates for this arthroscopic surgery.
Knee arthroscopy is a surgical procedure in which a small camera is placed into the knee. With this camera, the damage can be recognized. With small instruments and small shavers, the injured articular and meniscal cartilage can be repaired or partially removed. Loose bodies can be removed and inflammation can be excised. There are also new instruments to help seal frayed and irregular articular cartilage to try to stop the progression of arthritis.
In eight years of practicing sports medicine in this orthopaedic practice, I have performed greater than 1200 knee arthroscopies. Over this period of time, only eleven patients have gone on to total knee replacement. The majority of patients have marked improvement and are walking within two days without crutches or a walker. Return to activities such as golf and tennis vary per individual patient.
Not everyone is a candidate for arthroscopic surgery. It there is severe articular cartilage loss and bare bone is exposed, patients do not do as well arthroscopically. In these cases, if the patient suffers from severe pain, a total knee replacement can be performed. Other alternatives, depending on the severity of pain and limitation of motion, are anti-inflammatory drugs such as Celebrex, Vioxx, Bextra, and corticosteroid injections. Physical therapy to increase muscle strength and tone, weight loss to decrease the stress on the affected joints and Visco supplementation such as Synvisc can be beneficial.
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