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Experts advise against surgery for most patients with degenerative knee disease

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A recommendation published in The BMJ says that knee arthroscopy (keyhole surgery to relieve pain and improve movement) should not be performed in almost all patients with degenerative knee disease.

The recommendation applies to patients with or without imaging evidence of osteoarthritis, meniscus tears, mechanical symptoms, or sudden onset of symptoms. It was drawn up by an international panel which included orthopaedic surgeons, a rheumatologist, physiotherapists, clinicians and patients with experience of degenerative knee disease (including those who had undergone and those who had not undergone arthroscopy).

Current evidence suggests that arthroscopic knee surgery offers little benefit for most patients and is not cost effective, The BMJ explained.

For example, a randomised controlled trial published in The BMJ in June 2016 found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy. This study adds to the body of evidence suggesting that the benefits of arthroscopy may not outweigh the burden and risks.

Using the GRADE approach (a system used to assess the quality of evidence), the expert panel considered the balance of benefits, harms and burdens of the procedure, the quality of evidence for each outcome, typical and expected variations in patient values and preferences, and acceptability. They found that arthroscopic knee surgery does not, on average, result in an improvement in long-term pain or function for all or almost all patients with degenerative knee disease.

Because of this, they “strongly recommend” against arthroscopy for almost all patients with degenerative knee disease.