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14.11.2018 02:31:27
The number of meniscal operations has almost doubled in the last decade. At the same time, studies that questioned the benefits of widespread intervention, especially in degenerative, age-related meniscal damage, have appeared time and again.
If the patient has knee pain and a tear in the meniscus can be seen on the MRI image, then it seems appropriate to remove the defective meniscal tissue in the course of a joint mirroring. However, several years have shown that the surgery is not always useful, especially for age-related injuries.
The latest research comes from Finland and was published at the end of 2013 in the prestigious New England Journal of Medicine: 146 patients with a degenerative meniscal tear but no osteoarthritis in the joint received a joint scan. The half was actually operated. The other half only simulated meniscal treatment. It turned out that the pain often improved without intervention, or that a sham operation produced the same result as a real intervention.
Although experts in the study allege certain methodological shortcomings in patient selection, experts agree that the study addresses a real problem.
The figures of the Federal Statistical Office point to the fact that some are taken unnecessarily to the knife. According to the Medical Statistics of Hospitals, 10'417 partial or total removals were carried out in Swiss hospitals in 2002, compared to 18'903 in 2012.
According to Bernhard Christen, President of the Swiss Society of Orthopedics and Traumatology, the medical need can not explain this increase in intervention alone. Rather, he sees the cause as a trivialization of the procedure. The temptation to operate is great for both doctors and patients. Finally, on the MRI image with the meniscal tear, the doctor has discovered the seemingly obvious cause of the pain. And the inhibition threshold for patients to agree to the procedure is low, since the operation is performed on an outpatient and arthroscopic basis - ie using keyhole surgery.
But especially in older people, the two crescent-shaped menisci often show age-related damage as a result of years of wear and tear. Often, however, these cracks do not even make complaints. For example, an American study shows that in MRI, between every five women between fifty and sixty-five, and more than one in two men, between 70 and 90 menopausal or even destroyed menisci can be seen. However, in six out of ten people examined, the damage caused no pain.
MRI images are therefore not the only basis for decision making for meniscus surgery. Respectable orthopedic surgeons always clarify in knee pain with suspected wear-related meniscal tear, whether, for example, knee osteoarthritis, muscular problems or inflammation of the tendon insertions may be responsible for the problems.
In addition, the course of the pain plays an important role over time, because age-related meniscal complaints can resolve independently. Therefore, if a degenerative meniscal tear is detected in the elderly, it should always be treated conservatively.
Protection of the knee joint by relieving (reduction of the activities up to the stick unloading), regular high storage and placing of ice or coldpacks, respectively the application of wrapping (for example quark, hay flowers, etc.).
In addition, anti-inflammatory analgesics can help.
Targeted muscle training using physiotherapy can strengthen the knee and help to relieve the painful inflammation.
Sometimes the use of cartilage-building drugs in tablet form also helps.
Only when these conservative therapies are unsuccessfully exhausted can surgery make sense.
