Most of us know someone who has had their knee scoped (also called arthroscopy) to “clean up” arthritis or a meniscal tear. Often, patients are told that the scope will delay or even prevent the need for a later knee replacement because the scope will reduce mechanical friction/rubbing in the knee. This seems fairly logical, however, research is now showing that this is not the case. Last week, one of the world’s leading medical journals, the British Medical Journal (BMJ) published guidelines making strong recommendations against knee scopes for degenerative knee disease. This review of available quality studies (systematic reviews) found that when compared to conservative care, knee scopes:
Lead to increased odds of joint replacement!
Offer no significant pain reduction in either the short (3-month) or long (2-year) term.
Offer no improvement in function in either the short (3-month) or long (2-year) term.
Offerno improvement in quality of life in either the short (3-month) or long (2-year) term.
Typical scars from a knee scope – are they worth it?!
As you can imagine, these findings are causing a lot of controversy in the orthopedic world! Knee scopes have been used for many years, with both patients and surgeons reporting good satisfaction rates. You may have experienced it yourself – knee pain that did not improve until you had a knee scope. So how can this research be showing that it doesn’t help?!
We need to keep in mind that research focuses on statistics and large groups of people as a whole; it cannot tell us that a knee scope wasn’t helpful for an individual person. If you experienced relief from a scope, I am certainly not going to tell you that the relief you’ve experienced isn’t real! We also have to keep in mind that the body isn’t a mechanical machine like a car; it is far more complex and dynamic, and there are almost certainly factors affecting the success of the various conservative treatments you might have tried prior to a scope that we don’t completely understand. For example, you might have received treatments that we now know don’t help with arthritis (such as ultrasound), or perhaps the PT exercises you were prescribed weren’t challenging enough to aid healing (another rapidly evolving area of research).
So, what should you do if you have knee pain or have been diagnosed with arthritis or a degenerative meniscal tear, and are considering a knee scope? Even if you are already considering surgery, this research can absolutely help you maximize the odds that you find permanent relief and avoid a total knee replacement for as long as possible. Before you go for the knee scope, I would recommend giving physical therapy a trial first, specifically, PT that uses a graded exercise approach. In other words, the PT will prescribe you a set of exercises to perform over a few weeks and will progress the difficulty of the exercises as you strengthen – typically every 1-2 weeks. This is a bit different than the common 2-3 times a week for 4-6 weeks PT schedule that is common; PT visits this frequently typically build in many other passive treatments alongside the exercise. But research shows that passive treatments like ultrasound don’t help arthritis. A longer-term approach to exercise will strengthen and rebuild the muscles, tendons, and other knee structures, while also changing how the brain perceives pain. If you consider how long it took for the knee to degenerate into the state it’s currently in, it makes sense to also give it longer than 4-6 weeks to improve before resorting to surgery. Runners might want to continue running, and non-runners might want to consider slowly taking it up as there is good research suggesting running might slow down or even reverse arthritic changes (see our recent blog!).
My aim in sharing this is not to criticize orthopedists – I am thankful to know some great orthopedic surgeons because sometimes surgery is absolutely the right answer! Nor would I say that physical therapy is always the right treatment. But I do want my clients and readers to be able to make decisions that are well-informed, and to find healing with the safest, most conservative treatment that is effective for them! What that looks like will be a little bit different for each person.
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