New study suggests common arthro surgery for knees is unecessary

[Benny Profane]

Maybe belongs in gimp world, but, only gimps go there ( sorry gimps. I was a gimp all last winter, too)

Interesting stuff. Remember, doctors make nothing from physical therapy.

http://www.nytimes.com/2013/12/26/he...ggests.html?hp

[strawjack]

I went a ski season without surgery and then had my meniscus scoped in May. It worked out for me as it made a big difference and the surgery was quick and easy. Granted I did not go thru PT that winter. Maybe I should have, but I don't know how that would have helped. It was pretty clear on the mri that my stringy piece of meniscus was irritating the joint. Once that was cleaned up the pain went away.

Arthritis is a different story.

Still, I think every case is unique and most likely Dr's operate way too often on everything.

[old goat]

Back in the day I had a meniscal tear in January--clinical diagnosis--MRI didn't exist back then. The only treatment I had was waiting for the major swelling to go down and then resuming activity as I was able. By April I was able to manage a simple tour (by sidehilling up one side of a canyon and back down the other so my bad knee was able to stay straight). By the summer the knee was normal. It's been fine for over 30 years.

Unnecessary surgery is common. Combination of profit motive in fee-for-service medicine, surgeon training, and patient demand for the highest tech, most expensive option. The study is impressive. Not sure you could do a study that involved sham surgery in the US.

[splat]

There's a big part of me that wishes I had never let Doc Orr touch my meniscus and that I had just toughed it out until it was smooth again.

[stuckathuntermtn]

Idk, I've seen a lot of Drs over the years. There were 2.instances where surgery was a possibility, and in neither of those cases was it recommended. Once was for a badly broken hand when I was 15. Turns out they were right and I didn't need it. Second time was wrong. I actually did need shoulder surgery. A good Dr and even a good surgeon will typically still withhold surgery as a last resort. I suppose the modern thinking with knees is to just scope that shit because it's an easy procedure, but a good dr will express trying pt first if it seems like the right idea. YMMV

[Vinman]

"The study involved five hospitals and 146 patients, ages 35 to 65, with wear-induced tears and knee pain. About half had mechanical problems like locking or clicking knees."

To me this says these were not traumatic meniscal tears instead these were degenerative tears. Big difference.

I do agree that rehab for degenerative tears is sometimes helpful, even with traumatic tears if they are small enough and in the area of the meniscus that has blood supply. Large traumatic tears in areas of the meniscus with little to no blood supply don't do well with rehab alone.

[justr]

Yes, the study was about a specific-- and common, read non traumatic-- surgery.

Over the last decade at least more and more studies are showing that surgery really should be a last resort. This is one more piece of that puzzle.

[cat in january]

Had meniscus surgery 15 years ago. Landed a big jump wrong 3 years ago. Saw orthopedic surgeon again and he drew a large syringe of blood from the knee and sent me to get an MRI with the expectation that probably I had a torn ACL. Luckily just a meniscus tear. He thought I should get surgery, but my primary advised against it, "once it is gone, it is gone and the knee will likely have more problems." Went with the primaries advice.

At times the knee can stiffen up, but I just force it through range of motion, pop some IB, and the stiffness goes away.

Used to think I was headed towards a knee replacement due to abuse mostly from skiing. Now more hopeful.

My brother had an interesting comment a while back, "Nursing a long term injury can be one of the best things for your health"

[retirwntm]

This doesn't strike me as conclusive but the study is interesting. My experience with Drs. and surgeons especially is that they pride themselves on being problem solvers and almost always think their opinion is the only correct and absolute truth. As a result, surgeons always seem to want to perform surgery - unless they don't think they can fix the problem, at which point they pretty much leave you to your own devices.

I've had 2 yrs. since a partial tear on my meniscus. Went to a respectable sports team surgeon that I knew pretty well. He wanted to do a menisectomy (sp?) to resect the problem cartilage. I wanted to wait. I've rested it as much as possible to allow repair then rehabbed, biked, etc. as much as it would take without pain. When I had problems I backed off. I fucking miss soccer and skiing. It's been a long road but my knee feels better currently. I'll be testing the water with some turns this season and see how it goes.

TLDR; be personally responsible for your own decisions and the consequences and hope you made the right one. Be smart and humble enough to admit when you didn't and fix the problem and move on.

[chewymix]

I tried to rehab my tear for 2 years but in the end the locking got too much and I had to have it trimmed. If I just had pain I would maybe have not had it done but in the end my hand was forced. That said I ended up with 2 surgeries as my first ortho was a clown but the second was perhaps the uk's most experienced meniscus transplant doc and so far so good.

Next step, if I need it, would be a transplant.

[Vinman]

One issue I see with folks waiting too long with a tear that needs to be surgically addressed is that they end up beating the crap out of whatever viable material was left, resting in a bigger injury and the surgeon needing to remove more material tha they would have if they had just gotten it over with early on.