Osteoarthritis

Panel makes strong recommendation against knee arthroscopy


Knee arthroscopy should not be performed in almost all patients with degenerative knee disease, a multidisciplinary panel of international experts recommend. 

Writing as part of The BMJ’s ‘Rapid Recommendations’ initiative the experts, including rheumatologist and epidemiologist Professor Rachelle Buchbinder and Orthopaedic surgeon Professor Ian Harris say that a review of the evidence shows the common orthopaedic procedure does not, on average, result in an improvement in long term pain or function to all or almost all patients with degenerative knee disease.

“Our strong recommendation against arthroscopy reflects a low value on a modest probability (<15%) of small or very small improvement in short term pain and function that does not persist to one year, and a higher value on avoiding the burden, postoperative limitations, and rare serious adverse effects associated with knee arthroscopy,” they wrote.

They suggest that healthcare administrators and funders could use the number of arthroscopies performed in patients with degenerative knee disease as an indicator of quality care.

Further research was unlikely to alter their recommendation, they added. 

The recommendation was based on two systematic reviews: one on knee arthroscopy compared with nonsurgical care and one on the application of minimal important differences for patient important outcomes in patients with degenerative knee disease.

Speaking to the limbic Rachelle Buchbinder said the recommendation was consistent with “all the other guidelines regarding lack of benefit over placebo and conservative care for middle aged and older people with knee pain due to osteoarthritis including meniscal tears.”

 

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