To Scope or Not To Scope.....

If you are middle-aged or older, there may come a time when you experience some knee pain. You may see your doctor who will order and MRI, and it likely will show a meniscus tear. After a visit to an orthopedic surgeon, having your knee scoped will be recommended. But...is this really needed? Is this really the best thing for your knee long term?

Like many other things seen on an MRI scan, degenerative meniscus tears are very common in people without pain.  Given that this is the case, we have to be suspicious when this is the reason given for a gradual onset of knee pain. In addition, if this were the cause of knee pain, we would expect that people who had a surgery for their knee pain would do better than those who did not. However, we do not find this is the case. 

In a 2002 study published in the New England Journal of Medicine, the researcher separated patients into 1 of 3 groups. The first group received a knee scope with debridement (they cleaned out the torn meniscus). The second group only had lavage done (the rinsed the knee with sterile water but did not take anything out). The third group received a sham surgery (scope holes were made, but nothing was done in the joint). All three groups received normal physical therapy after the surgery. If the meniscus was the cause of pain, we would expect the surgery to clean out the meniscus to do better than the other two. Surprisingly, this was not the case! There was no difference between the three groups! Maybe the rehab is the most important part of recovery. 

What if surgery is compared to no surgery in middle aged and older people with meniscus tears and arthritis? Just this past August, a study was published in the Journal of Arthritis and Rheumatology which examined this very thing. The authors found that there was no difference between the two groups at 3 and 12 months following the surgery. So, degenerative meniscus tears with our without arthritis can be managed without surgery. 

The orthopedic surgeon may tell you that the surgery is simple and recovery is fast. They may also justify the surgery by telling you it is better than a knee replacement and will "buy you some time." However the  study referenced above also  showed that patients who had their knee scoped had an increased risk of moving on to have their knee replaced more often than those that did not have their knee scoped. So, in effect, it may have moved them more quickly to having their knee replaced. 

Now, I am not saying that a knee arthroscopy is never needed in a middle-aged or older adult. However, you do need to know that there are other options which may be better for you-which, by the time you get to a surgeon, likely will not be discussed. 

Most knee pain can be appropriately managed conservatively with a comprehensive therapy program consisting of education about your problem and advice on short-term activity modification as well as treatment to help decrease pain, and then eventually strengthen and build your knee and surrounding musculature up. It is the approach that I take with my patients to help them avoid surgery and get back to doing all of the activities that they want to be able to do. 

If you have questions, feels free to reach out to me. 
Thanks for reading,

​Bob