Is This The Most Overdone Surgery In All Of Medicine?

Summary

In this video, the surgeon discusses the overuse and potential harm of knee arthroscopy, particularly for degenerative meniscal tears in older adults. While arthroscopy is effective for younger patients with traumatic tears, removing or cleaning up meniscal tissue in older individuals can accelerate arthritis and reduce the knee's lifespan. Despite studies showing minimal benefits for degenerative cases, many patients still opt for surgery, often leading to more rapid joint degeneration. The surgeon emphasizes the importance of non-surgical treatments and cautions against quick fixes, encouraging patients to allow the knee to adapt naturally over time.

Takeaways

• 😀 The most overperformed surgery in medicine is knee arthroscopy for meniscal tears, particularly degenerative ones.
• 😀 The meniscus is a C-shaped cartilage that cushions the knee joint, and it can tear due to trauma or degeneration over time.
• 😀 There are two types of meniscus tears: traumatic (usually in younger individuals due to high-impact injuries) and degenerative (more common in older individuals).
• 😀 Degenerative meniscal tears are often caused by mucinous degeneration, where the tissue becomes gooey and loses its structure, typically after age 40.
• 😀 Surgery to remove damaged meniscus tissue, known as a meniscectomy, was shown to be largely ineffective for treating degenerative meniscal tears in studies from 2002 and 2012.
• 😀 Removing the meniscus through surgery can accelerate arthritis progression, as it changes the cartilage environment and the knee cannot adapt properly.
• 😀 The meniscus also plays a crucial role in knee stability and in reducing stress on the knee's cartilage, especially the articular cartilage.
• 😀 In the 1970s, it was common to remove the meniscus completely in young athletes, but this led to arthritis development within a decade, proving its importance in joint health.
• 😀 Many patients with degenerative meniscal tears can manage their symptoms without surgery, through physical therapy, anti-inflammatory medications, and activity modification.
• 😀 Knee arthroscopy can shorten the lifespan of the knee and complicate future knee replacement surgeries due to increased risk of infection and bone density changes.

Q & A

What is the role of the meniscus in the knee joint?

The meniscus is a C-shaped fibrocartilage structure that sits between the bones in the knee joint, serving as padding, reducing forces on the knee, and providing some stability. It also helps the femur fit more appropriately with the tibia, contributing to the knee's proper functioning.

What are the two main types of meniscal tears mentioned in the video?

The two main types of meniscal tears are traumatic tears and degenerative tears. Traumatic tears typically occur in younger, healthier patients due to high-energy activities like sports, while degenerative tears are more common in older individuals, caused by wear and tear of the meniscus over time.

Why are degenerative meniscal tears difficult to repair?

Degenerative meniscal tears are difficult to repair because the meniscus loses its blood supply and nerve endings, which means it can't heal itself effectively. As a result, surgery often involves removing the damaged tissue rather than repairing it.

What did the landmark studies in 2002 and 2012 suggest about meniscus surgery?

The landmark studies in 2002 and 2012 showed that surgery for degenerative meniscal tears and arthritis is often ineffective. A Finnish study in 2012 even used sham surgery, showing no clear benefits in the group that received actual surgery, suggesting that the surgery might actually harm the knee in the long term.

How does meniscus surgery affect the progression of arthritis in the knee?

Meniscus surgery, such as meniscectomy (removal of the meniscus), can accelerate arthritis progression. Removing cartilage disrupts the knee's natural cushioning and increases stress on the joint, leading to faster wear and tear of the articular cartilage, which can result in earlier need for a knee replacement.

What is the 'chalk block phenomenon' in the context of the meniscus?

The 'chalk block phenomenon' refers to how the C-shape of the meniscus helps distribute the load between the femur and tibia, stabilizing the knee. This analogy is compared to using chalk blocks under a wheel to prevent movement, as the meniscus helps the knee joint function more smoothly and with less friction.

Why were younger athletes once recommended to remove the meniscus after an injury?

In the past, the standard treatment for young athletes who tore their meniscus was to remove it entirely. This was based on the belief that the meniscus wasn’t essential. However, this led to premature arthritis in many cases, prompting a change in approach to preserve the meniscus as much as possible.

What is the long-term risk of repeated knee arthroscopies?

Repeated knee arthroscopies, especially when performed on older adults, can lead to the rapid development of arthritis. Each surgery damages the knee further, removing cartilage and disrupting the knee’s natural adaptive processes, which shortens the joint's lifespan and often leads to earlier knee replacement.

What alternative treatments are recommended for meniscal tears instead of surgery?

Instead of surgery, physical therapy, anti-inflammatory medications, and activity modification are recommended for managing meniscal tears. These approaches help reduce pain and allow the knee to adapt naturally. For most people, the knee heals over time without the need for surgery.

Under what conditions would arthroscopy be considered for degenerative meniscal tears?

Arthroscopy may be considered for degenerative meniscal tears if there are mechanical symptoms such as locking or catching of the knee, or if a large flap of the meniscus is causing damage to other parts of the knee. Otherwise, non-surgical treatments are preferred, as surgery can accelerate arthritis progression.