What I’m about to share is not new information. It has been a known fact for many years that an arthroscopic partial meniscectomy is a procedure whose advisability should be questioned. There is considerable concern about whether it does any good and whether it contributes to the arthritis burden an individual develops later in life.
The human knee has two semi-lunar cartilages called menisci. Each knee has a medial (inside) meniscus and a lateral (outside) meniscus. They are called semi-lunar because they are crescent-shaped and resemble a crescent moon. They provide cushioning between the cartilaginous surfaces of the thigh (femur) bone and the shin (tibia) bone that form the knee joint. The knee joint is subjected to wear and tear and trauma all the time, and a victim of this activity is the meniscus. Running, jumping, walking, squatting, pivoting, and quick changes of direction place a lot of stress on the menisci. Both normal wear and tear and trauma can cause tears in the menisci and cause pain, swelling, clicking, and locking of the knee. This happens when the torn fragment gets displaced and interferes with the normal movement of the joint.
The obvious solution to that problem is to remove the torn cartilage fragment, or the entire meniscus, if it has degenerated significantly. This removes the cushioning between the bone surfaces and subjects the joint cartilage to a higher degree of trauma leading to arthritis of the knee joint. Just opening the knee joint and traumatizing the joint surfaces causes arthritis. To prove a point, a group of Finnish orthopedic surgeons assembled 146 patients with degenerative meniscal tears, but with no arthritis. Any patient with a traumatic meniscal tear from an injury was excluded. The 146 were divided into two groups—group one had arthroscopic partial meniscectomy and the other group had sham surgery (incisions were made, but the joint was not entered).
At 12 months and 24 months the results of “surgery” were assessed. Specific measures and indicators we’re used to determine if surgery was effective. “Although both groups had significant improvement in all primary outcomes [measures], the patients assigned to the arthroscopic partial meniscectomy [group] had no greater improvement than those assigned to sham surgery.” That’s like saying “When I had a headache, I got the same relief from taking both 2 aspirin as I did from 2 sugar pills (placebo).”
This result brings into question the efficacy of an arthroscopic partial meniscectomy. Patients are better after having the procedure, but no more than the patient who only had skin incisions. The other concern about this procedure is that it often leads to a more rapid onset of arthritis. Plus these folks very often end up needing total knee joint replacement surgery down the road. The intent of arthroscopic surgery was to cause less trauma to a joint being operated upon, to shorten recovery time, and reduce the amount of pain a patient has. It does all that, true, but Mother Nature doesn’t like her joints being messed with, so the natural evolution of knee arthritis is often accelerated by arthroscopic surgery.
I certainly don’t know the answer to this dilemma. The concept of arthroscopic partial meniscectomy is good, but it needs to be studied to find a counter measure for unimpressive outcomes. Or a different surgical method or an intra-articular treatment need to be devised.
References: Melegrito RAT, 1 of the Most Common Knee Surgeries May Be Doing More Harm Than Good. The Epoch Times Sample Issue; B7.
Sihvonen R. et al. Arthroscopic partial meniscsctomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomized controlled trial. Ann Rheum Dis 2018;77:188-195.
Sihvonen et al. Arthroscopic Partial Meniscectomy versus Sham Surgery for Degenerative Meniscal Tear NEJM 2013 Dec 26;368(26):2515-2523.
