It has been well accepted in the Orthopedic literature that meniscus tears nearly always exist in knees with osteoarthritis (OA). The more advanced arthritis, the more likely the presence of a meniscus tear on MRI (75% of the time in mild-moderate OA and 100% in advanced OA). It is very common for a medical provider (especially non-specialists) to reflexively order an MRI for a patient with new onset knee pain to “search” for the cause.Many of these patients are then referred to the Orthopedic surgeon to treat the meniscus tear without understanding the “big picture”. Often when an orthopedic specialist evaluates a patient, all that is needed to make the correct diagnosis is a thorough exam and review of correctly taken weight-bearing x-rays. Oftentimes, an MRI simply confuses patients and leads to unnecessary surgery. If there is evidence of loss of joint space, osteophytes or significant subchondral sclerosis (all are evidence of OA on x-ray) and the patient is over-weight or obese (BMI > 25), it is likely that any surgery to treat incidental meniscus problems found on MRI will lead to a more rapid progression of the arthritis. Many past studies have proven that arthroscopic surgery does not provide long term relief for knees with moderately severe tp advanced osteoarthritis and should not be performed. A new multi-center study demonstrates that even in the presence of a meniscus tear, knees with osteoarthritis worsen at a much faster rate when surgery is performed to treat the tear. This raises further questions regarding whether the meniscus still provides some function, even when torn, or if it may be best to simply leave it alone. We have found that patients actually respond well to surgery, with results lasting 2-5 years with substantially improved quality of life. The issue now becomes whether or not that improved “short term” quality of life is worth the consequence of a faster onset of OA. Dr. Bailie believes that each patient simply needs to be educated on the scientific research and expectations in order to make the right decision for themselves regarding surgery. Insurance companies will very likely use this data to disallow ALL arthroscopic surgery in middle-aged patients with BMI > 25 who display evidence of any arthritis on imaging. This, unfortunately, may take the decision making power out of the patient-physician relationship in the future.
Click on the articles below to read several studies
Physical therapy better than surgery in knee arthritis and meniscus tears
Obesity negatively affects outcomes of knee meniscus surgery
Arthroscopy not helpful for meniscus tears with OA
Partial Meniscectomy not helpful if OA present and worsens OA
