Arthroscopic Knee Surgery

By Dr Daniel Meyerkort – Perth Orthopaedic & Sports Medicine Centre

Results of Arthroscopic Knee Surgery for Arthritis / Meniscal tearing

Knee arthroscopy should not be first line treatment for patients aged over 50 with degenerative arthritis of the knee. This applies to both patients with or without a degenerative meniscal tear. This has been supported by multiple placebo-controlled RCT’s. The trials that are most famous are published in the New England Journal of Medicine (NEJM). The first trial, published in 2002, showed no difference in arthroscopy v placebo in patients with knee arthritis. In 2013 a placebo controlled study was published analysing the results of arthroscopic partial meniscectomy for degenerative meniscal tears. Again, this study found no difference was found between the two groups. It should be noted that in both studies however, improvement in pain and function was seen in both groups, indicating a significant placebo benefit.

Evidence for Knee Arthroscopy for Arthritis / Meniscal Tear from the New England Journal of Medicine

Link to Full Text – NEJM 2002 Placebo Knee Arthritis

Link to Full Text – NEJM 2013 Placebo Degenerative Meniscal Tear

Who may benefit from knee arthroscopy?

Despite these trials, a subset of patients with acute meniscal pathology still benefit from knee arthroscopy. Classically the onset of acute pain is accompanied with localised tenderness at the medial joint line. MRI scanning shows meniscal tearing with preservation of the knee articular surface. It is reasonable to consider knee arthroscopy if symptoms do not improve with a physiotherapy program.

Role of Arthroscopy in Knee Arthritis:

Indications include:

  • Loose body removal
  • Treatment of locked knee/mechanical symptoms
  • Lateral release

 

Learn about Robotic Partial Knee Replacement

Learn about Robotic Total Knee Replacement

FAQS

IS IT WORTH HAVING KNEE ARTHROSCOPY

If you have knee arthritis or wear and tear, knee arthroscopy should not be your first treatment. Muscle strengthening and weight loss should be first line treatment. Knee arthroscopy has been shown to be no better than placebo ‘pretend’ surgery. Sometimes patient have loose bodies or mechanical symptoms and do benefit from knee arthroscopy but these patients are in the minority.

IS KNEE ARTHROSCOPY PAINFUL?

Your knee may be a little sore and swollen for 1 – 2 weeks after surgery. You will be fully weight bearing immediately and start rehabilitation with the physiotherapist shortly after surgery. Most patient have manageable levels of pain and simply need paracetamol or anti inflammatory for a couple of weeks after surgery.

CAN YOU WALK STRAIGHT AFTER KNEE ARTHROSCOPY?

Yes, you can walk immediately and will be discharged from hospital the same day. Mobilisation and strengthening of your knee are good to commence as your pain settles.

WHAT IS THE SUCCESS RATE OF ARTHROSCOPY?

The success rate depends on the underlying state of your knee. The success rate is low for patients with advanced arthritis of the knee, they would be better to proceed to knee replacement. For isolated meniscal tearing with mechanical symptoms, the success rate is in the order of 80%. Over a long period of time, the success rate decreases as many patients arthritis will progress.

WILL WALKING ON A TORN MENISCUS MAKE IT WORSE?

In general if you are aged over 50 and have a degenerative tear of your meniscus, walking and physical exercise will not make it worse. Physiotherapy has been shown to be effective for reducing pain from degenerative meniscal tears. If your pain does not settle with Physiotherapy and you have mechanical symptoms you can proceed to knee arthroscopy to trim your meniscus.

CAN A MENISCUS TEAR LEAD TO KNEE REPLACEMENT?

Studies have shown that arthroscopic knee surgery for meniscal tearing can lead to an increased risk of future knee replacement. For this reason first line treatment should be Physiotherapy and weight loss if needed. Arthroscopic knee surgery should be reserved for cases that do not settle with simple measures.

HOW BAD DOES A MENISCAL TEAR HAVE TO BE TO UNDERGO SURGERY?

Meniscal tears that are painful, have mechanical symptoms (clicking, catching or locking) and have not settled with Physiotherapy are good tears to undergo surgery.

WHAT IS THE BEST EXERCISE FOR A TORN MENISCUS?

Low impact lower limb strengthening with your physiotherapist is the best exercise for a meniscal tear. These can include quads sets, hamstring curls, straight leg raises, shallow squats and bike riding.

IS CORTISONE USEFUL FOR A MENISCUS TEAR?

Cortisone can be useful to settle a painful flare from meniscus tearing or arthritis. This often enables you to start an exercise program with your physiotherapist.

IS IT OK TO RIDE A BIKE WITH A TORN MENISCUS?

Yes, bike riding is one of the best forms of exercise with a torn meniscus. It will not lead to further damage and often leads to pain relief and better knee function.

CAN THE MENISCUS BE REPAIRED?

Yes, young patients with large tears in the area of meniscus that has a good blood supply can be repaired. Older patients with degenerative tears usually are not able to be repaired and the meniscus is simply trimmed.

Clinic Locations

West Perth, Joondalup, Canningvale