When an individual suffers from pain due to an injury such as a torn knee cartilage, he or she may turn to surgery to resolve the problem. However, in some instances, “tincture of time” can be just as effective as an operation. In addition, it has no risk of an adverse event that can accompany or follow a surgical procedure. Adverse surgical events encompass anything from a short-term infection to death. Finnish researchers conducted a study in which they compared the results of a sham knee operation to a real surgical procedure. They found that the results were similar to a real surgery for reducing pain and other symptoms in some patients suffering from torn knee cartilage. They published their findings on December 26 in The New England journal of Medicine.
The orthopedic procedure that the researchers investigated was an arthroscopic partial meniscectomy, which is one of the most common orthopedic procedures performed in the US. As many as 700,000 Americans undergo surgery each year to treat tears in a crescent-shaped piece of knee cartilage known as the meniscus, which serves as a shock absorber between the upper and lower portions of the knee joints. A meniscectomy is an arthroscopic procedure, performed through small incisions with the aid of a small camera inserted into the joint.
The study group comprised 146 patients 35 to 65 years of age who had knee symptoms yhat were most likely due to a degenerative medial meniscus tear; in addition, the patients did not have any evidence of osteoarthritis of the knee. The researchers conducted a multicenter, randomized, double-blind, sham-controlled trial (patients from several facilities either underwent a sham operation or a real surgery and neither the patients nor the researchers were aware of who received the actual operation). The primary outcome measurements were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (both scores ranged from 0 to 100; lower scores indicated more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10 (0: no pain; 10: severe pain)) at 12 months after the procedure.
The researchers found that there were no significant differences between the two groups in regard to the change at baseline to 12 months postoperatively in any of the primary outcome measurements. The aver changes (improvements) in these measurements were: Lysholm score, 21.7 points in the partial-meniscectomy group, compared to 23.3 points in the sham-surgery group (between-group difference: −1.6 points); WOMET score, 24.6 and 27.1 points, respectively (between-group difference,: −2.5 points); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference: −0.1). In addition, the researchers found no significant differences between the groups in regard to the number of patients who required another knee operation (two in the partial-meniscectomy group and five in the sham-surgery group) or serious adverse events (one in the partial-meniscectomy group, and zero in the sham-surgery group).
The researchers concluded that the outcomes after arthroscopic partial meniscectomy were no better than those following a sham surgical procedure.
Take home message:
The body has an ability to heal itself; thus, for a number of non-life-threatening conditions, it might be advisable to discuss alternatives such as physical therapy or just watchful waiting with the surgeon. Obtaining a second opinion may also be helpful.