SCIENCE FRIDAY: GOOD NEWS FOR KNEES; LESS SCOPES & SURGERIES

Snowy beach path through the dune. Taken by PKSenagore January 3, 2019. All rights reserved.

A TREND TO TREAT NON-ACUTE KNEE PROBLEMS WITH PHYSICAL THERAPY AND MEDICATIONS, has translated into data showing less surgeries are being performed. An article by Harvard Health Publishing editor Robert H. Schmerling MD, indicates a decline in “open” surgeries has been followed, decades later, by a reduction in the number of arthroscopic procedures to fix conditions in which knee joint motion is preserved.  Mostly these conditions are common causes of knee pain, such as osteoarthritis, and are not the result of acute sports trauma. 
 
Dr. Schmerling indicates that, for example in the case of torn cartilage, “studies have demonstrated convincingly” that in “many instances of torn cartilage that do not block joint motion”, other remedies like medication and physical therapy “may work just as well as arthroscopic surgery”. The doctor said that until recently “despite these recent data, some orthopedists continued to recommend arthroscopic surgery for these conditions”.  But a change is being noted.  Declines were seen over the period of 2002-2015 in Florida study that are reported on in the HHP article. 
 
Schmerling discusses reasons why the change may be slow in coming and whether this trend is good for patients.  
 
Athletes with chronic knee pain that has worsened over years may wish to investigate the possibility of trying non-operative, non-arthroscopic treatments rather than immediately undergoing the minimally invasive procedure, if advised so by an orthopedic surgeon. 
 
As Schmerling indicates, the causes for the trend have not been completely studied but, as he says, “it is reasonable to assume that knee arthroscopies are being performed less often because we better understand when they are likely to help and when they are not”.
 
Perhaps referring to the HHP article can assist with starting such a discussion with your surgeon.
 
A little more than a year ago I was looking for help with a non-traumatic knee condition that, described as above, was not amenable to arthroscopic repair. An expert orthopedic surgeon recommended a program of knee-friendly strength exercise and aerobics, stretching and mobility work, and continuing to maintain body weight in the normal range. He did not advise surgery. After all these months, my knees feel wonderful without medication and I’m able to work at and enjoy a variety of low impact recreational sport activities.
 
I competed in an 8K this past Thanksgiving, walking to 3rdplace gender/age group finish. The complex meniscus tear and osteoarthritis that was diagnosed 1 year earlier had benefitted from the extra rehab work!
 
Check out the Harvard Heath Publishing article for greater understanding.
 
RUN & MOVE HAPPY!
 
https://www.health.harvard.edu/blog/surgeons-are-doing-fewer-knee-surgeries-2018122715656