Knee pain is common in all ages but moreso in over 50’s. When it comes to knee pain, arrival at a physiotherapy clinic is almost inevitable, and many believe that surgery is the only option for them. This is true if they have severe degenerative knee pain confirmed by radiological investigation, and once all conservative treatment options have been exhausted. This does not discourage many patients requesting more minor surgeries by arthroscopy, such as debidement, wash-out and meniscectomy, before trying exercise as a management plan. Worryingly knee arthroscopy is the most performed orthopaedic procedure performed around the world.
Current guidance does already discourage against the use of arthroscopy for patients with clear radiological evidence of OA. The evidence is murkey for pathologies without evidence and the same can be said for other common pathology. Sometimes this is because of incorrect terminology and explanation of pathology to patients and between healthcare professionals.
The term degenerative knee can be the cause of the confusion and is often used as a synonym for osteoarthritis. In reality it should be used for people over 35 with or without one of the following:
- Imaging of OA
- Meniscus tear
- Mechanical symptoms aside from persistent locked knee
- Acute or subacute symptoms.
A randomised controlled trial published in The BMJ in June 2016 found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy. A panel then met to discuss and review the growing body of evidence which suggests that arthroscopy is not effective for many different knee pathologies which have been traditionally manged by arthroscopy. This meeting is where this systematic review and guidance was created.