Friday, September 23, 2011

Is Knee Surgery for Cartilage Lesions a Waste of Time?

From the world of science comes this study :
A long-term follow-up of 43 patients who were treated for ACL tears but untreated for associated knee cartilage lesions showed that the group did just as well as patients without cartilage lesions who underwent similar ACL treatments.
The defects were either grade 3 or 4 -- indicating that at least half the cartilage was gone, if not all. They were at least 2.6 square centimeters in size (that's a bit bigger than a circle with a diameter of half an inch). So these weren't teeny, tiny lesions.

For the study, patients were evaluated 10 and 15 years after having surgery for ACL tears. Those who, during surgery, were found to have the severe lesions had the same clinical outcomes (following the same rehab regimen after the operation) as those who didn't have lesions.

Conclusion (according to one of the researchers, Wojciech Widuchowski):
"Our study seems to reinforce the question whether treatment of a symptomatic lesion provides improvement over that of the natural history."
Widuchowski noted that applying these findings could represent significant cost savings for health care systems and possibly reduce the tens of thousands of knee arthroscopy procedures done annually in the United States alone.
Where I stand on all this is not hard to guess. I'm a "surgery as a last option" kind of guy. In Saving My Knees, I cite two studies, including a bombshell one from the New England Journal of Medicine, showing that surgeries to clean up bad cartilage are pretty much useless.

Now it's true that this particular study wasn't designed specifically to answer the question, "Is surgery for knee cartilage lesions effective?" Remember, the patients were already being operated on to fix the ACL tears, and so the surgeons simply had to choose whether or not to "clean up" nearby cartilage problems (probably by smoothing out the tissue, or even using microfractures to generate new cartilage). Normally, it appears the bias is toward intervention -- doing something. But this time the surgeons refrained from treating the large defects. And the outcomes (one infers) were the same (if not better) than if they had tried to fix the cartilage.

So these poor patients were stuck with those lesions? That doesn't sound good. But remember -- cartilage can heal. Also, a lesion isn't necessarily your problem, pain is.

After all, over the age of 30, more people have cartilage lesions in their knees than don't. The mere existence of a defect doesn't automatically signify knee pain. Why should you care? Because if you do have knee pain -- and if you hear that dreaded crackle-crunch when you bend your knees -- you don't have to completely eliminate that noise to achieve a good life again.

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