Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms

Working in occupational medicine, I see many middle aged patients with knee pain. Often times these individuals have a history of knee symptoms with a recent flare up of their symptoms due to a recent injury. MRI evidence of these patient will likely show meniscal or chondral pathology consistent with degeneration. In other words, these patients have early arthritis. What is the best treatment course- surgery or conservative management?  

A recent systematic review was published on the benefits and harms of arthroscopic surgery for degenerative knees. The review found that the small benefit associated with arthroscopic surgery does not outweigh the benefits seen from 'exercise therapy.' Some of the harmful effects of surgery include DVT, pulmonary embolism, venous thromboembolism, infection, or even death. Current findings do not "support the practice of arthroscopic surgery as treatment for middle aged or older patients with or without signs of arthritis." 

How does this affect our practice? 
We need to educate our patients on the benefits of conservative management with degenerative knee pain. Surgery may present as a quick alternative, but the benefits do not out weight the potential risks. Educate your patients on knee osteoarthritis, exercise, and weight management. It is our duty to empower the patient to treat themselves with exercise vs. having surgery. 

Jim

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