14.11.2018
Surgery dramatically increases risk of joint wear and cartilage loss
Sick by knee surgery: The fact that many knee surgeries do more harm than good to the joint is already being discussed. Now radiologists are providing new evidence that meniscus surgery in particular promotes joint wear and cartilage damage. In their study, all participants operated on the meniscus later developed osteoarthritis, in the case of patients not operated on despite meniscal damage, however, it was only about half. The indications for a meniscus operation should therefore be fundamentally reconsidered, the researchers say.
The menisci are important shock absorbers and balancing cushions in our knee joint. The two semicircular cartilaginous pads resemble the curve of the femur like small wedges and thus stabilize the knee. At the same time, they are susceptible to injuries and wear, the meniscal tear is one of the most common knee injuries during sports or falls.
Typically, orthopedic surgeons or cracked menisci recommend surgery that mends the "shock absorber" and removes troublesome debris. This relieves the pain and should prevent further damage to the knee joint. But: "There is more and more evidence that meniscus surgery is more likely to damage the knee joint," says Frank Roemer of Boston University. He and his colleagues have therefore investigated how such an operation affects the cartilage in the knee joint and the risk of osteoarthritis.
For their study, the researchers evaluated data from the Osteoarthritis Initiative, a long-term study on knee osteoarthritis. They analyzed magnetic resonance images of the knee of 311 elderly patients being treated for meniscal damage. As a result, 31 patients were operated, 280 but not in spite of the sometimes equally serious damage. The scientists then examined how many of the patients developed arthritis or cartilage damage in subsequent years.
The result was shockingly clear: "Patients who underwent meniscus surgery had a greatly increased risk of developing arthritis and cartilage damage the following year," says Roemer. Of the 31 meniscus-operated patients, all later developed osteoarthritis in this knee, 80 percent showed severe cartilage loss. In the 280 patients without surgery only 59 percent suffered in the subsequent period of osteoarthritis, cartilage damage found the researchers only in 39 percent.
According to the researchers, this suggests that in many cases, meniscus surgery could do more harm than good. "The indications for such surgery need to be more cautious to avoid accelerated knee joint degeneration," says Roemer, who presented the study's findings at the Radiological Society of North America annual meeting. Instead, more conservative methods such as physical therapy and pain medication should be used.
