New Guidelines Say NO to Most ‘Keyhole’ Knee Surgeries

Clinical trials have shown that keyhole surgery doesn’t help people suffering from arthritis of the knees any more than mild painkillers, physical therapy or weight loss, said lead author Dr. Reed Siemieniuk. He is a health researcher with McMaster University in Toronto, Canada.

“You can make a pretty strong statement saying that from a long-term perspective, it really doesn’t help at all,” Siemieniuk said. “If they knew all the evidence, almost nobody would choose to have this surgery.”
Keyhole surgery is one of the most common surgical procedures in the world, with more than 2 million performed each year, Siemieniuk said. The United States alone spends about $3 billion a year on the procedure.

The new guidelines – published online May 10 in the BMJ – were issued as part of the journal’s initiative to provide up-to-date recommendations based on the latest evidence. The guidelines make a strong recommendation against arthroscopy for nearly all cases of degenerative knee disease.

This includes osteoarthritis as well as tears of the meniscus, the padding between the two leg bones in the knee, Siemieniuk said. “With age and use, the grinding of the two bones together can break down that padding,” he said. “It’s very common to see little rips and tears in that padding in patients with arthritis.” Siemieniuk and his colleagues noted that a trial published in 2016 showed that surgery was no better than exercise therapy in patients with a meniscus tear.

Despite this and other medical evidence, most guidelines still recommend keyhole surgery for people with meniscus tears, sudden onset symptoms like pain or swelling, or mild to moderate difficulties with knee movement.