Arthroscopy in middle and older aged patients

A controversial editorial appeared in the March 2016 issue of Acta Orthopaedica, a high profile Scandinavian orthopaedic journal. The editorial suggested that surgeons “abandon ship” on performing arthroscopic knee surgery in middle aged and older patients. One of the authors, Stefan Lohmander, an academic Swedish surgeon, was the Presidential Guest Speaker at the Australian Orthopaedic Association Annual Scientific Meeting in 2014 in Melbourne.

He points out that there is overwhelming evidence that knee arthroscopies in middle aged and older patients have no significant benefit over placebo or sham surgery. Any benefit was slight and temporary. He also noted that exercise therapy produces better results than arthroscopic surgery. The added benefit is that exercise therapy carries none of the risks of surgery.

Despite this evidence arthroscopic knee surgery continues to be used frequently for this group of patients. The reasons for this are complex, some of them driven by surgeon behaviour and some of them driven by patient expectation. Many patients come to the surgeon with an MRI which demonstrates a meniscal tear. These patients not unreasonably think that their torn meniscus is the cause of their pain and if surgically treated will resolve their problem. However meniscal tears in this age group are very common and most of them are asymptomatic.

Explaining these findings to patients is difficult and may be time consuming when patients arrive at the consultation with a strong belief that surgery is the best option for them. For many surgeons it is easier to simply book the patient for an arthroscopy.

For patients in this age group with knee pain, it is essential that they obtain as much information as possible and consider all options including exercise therapy and weight reduction before considering arthroscopic surgery.

The surgeons at KOG are willing to discuss this issue in more detail with patients at a consultation if they so desire.