Finnish study questions need for common knee surgery

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    A new study by researchers in Finland suggests a popular knee surgery may be unnecessary in many cases.

    The study focused on two groups of patients between the ages of 35 and 65, comparing the results of knee surgery with sham surgeries in which the patients’ knees were probed but damaged areas were not removed.

    MRIs tend to pick up all sorts of small issues in the meniscus, the cartilage that stabilizes and cushions the knee, according to Dr. Pekka Mooar, an orthopedic surgeon at Temple University. Patients with meniscus pain have high hopes for surgery, said Mooar, but the study confirms sometimes it’s better to find other solutions.

    “I think people expect that if they have a problem, it can be cured. They get an MRI — it shows a tear in miniscus, and they come to a doctor saying, I want to have my miniscus fixed,” Mooar said. They’re “driven by all sorts of expectation for medicine today.”

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    However, the study failed to consider activity level of participants as a variable in the level of knee pain patients reported, said Dr. James Carey, director of the Penn Center for Cartilage Repair and Osteochondritis Dissecans Treatment.

    Study researchers tested individuals with A-traumatic injuries, those less likely to benefit from the procedure, said Carey, a specialist in sports medicine. Generalizations should not be made about the usefulness of the surgery, emphasized Carey, who said most meniscus surgeries are performed after athletic injuries.

    “This study looked at a very specific subset of patients and that’s the most important thing to understand about it,” he said.

    The sham procedure can have a positive effect, said Dr. David Jevsevar, chairman of the committee on evidence-based quality at the American Academy of Orthopedic Surgeons.

    “It’s hard to be certain the study results are significant,” he said, because both groups did receive a form of treatment or arthroscopy.

    “The difficulty is how do we extrapolate that to practice and to what we’re doing right now. I think this is an incredibly important piece of the puzzle,” Jevsevar said. “We need now additional research to say … OK, what is the best treatment for these patients? What should we be doing?”

    About 700,000 patients undergo meniscus-repair surgery in the U.S. each year.

    The study was published in the New England Journal of Medicine.

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