Every day patients with knee arthritis ask me whether keyhole surgery (knee arthroscopy) would help them. The bottom line is that it is an excellent minor procedure for patients who have symptoms from obstructing lesions in the knee such as a torn meniscus (cartilage shock absorber) or loose body regardless of the presence of underlying arthritis. It is less useful for patients with simple ache from arthritis without any mechanical component. The trick is telling the difference and this requires experience.
Fifteen years ago many knee surgeons would have said keyhole surgery was worth a try for arthritis and to be honest far too many arthroscopies were being done. Since then there has been research showing that for simple knee arthritis keyhole surgery isn’t particularly effective. As a result there has been a change in practice and in some cases the pendulum has swung a bit too far the other way. I quite often see patients who have suffered for months with knee pain and been told they are either too old or have too much arthritis to be considered for keyhole surgery. They often have typical mechanical symptoms that developed quite suddenly, with severe intermittent pain, locking, and giving way. Most experienced knee surgeons would say that for these patients keyhole surgery can be extremely effective. Some of my happiest patients are those who have been told they needed a knee replacement because of a belief that keyhole surgery wouldn’t help, only to find that when the mechanical problem was dealt with by minor surgery the arthritis pain was manageable.
The good news here is that the Australian government is also on board with this point of view. Over the last couple of years they been reviewing Medicare funding for many procedures including keyhole surgery. This has involved reviewing all the evidence and consulting with stakeholders including doctors and patients. It will come into effect later this year. Knee arthroscopy will still be funded for patients with obstructing lesions in the knee regardless of the presence of arthritis.
This isn’t to say that keyhole surgery is for everyone. Some meniscal tears don’t cause mechanical symptoms and for these patients keyhole surgery is less likely to help. Some obstructing lesions may settle without surgery and a trial of non-operative management for a few weeks may be worthwhile if the pain is manageable. If you have severe knee arthritis and are looking for a definitive solution then knee replacement surgery is likely to be the answer. Most importantly if you have significant knee symptoms that are not settling it is worthwhile consulting with an experienced knee surgeon who can discuss the best treatment for you.
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- Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL. Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013 Dec 26;369(26):2515-24.
- Scillia AJ, McDermott JD, Issa K, Goljan P, Harwin SF, Festa A, McInerney VK. Arthroscopic Partial Meniscectomy for Meniscal Tears: A Review and Commentary on a Study by NEJM. J Knee Surg. 2016 Jul;29(5):387-90.
- Keene, GK. Arthroscopy for knee arthritis +/- meniscal tears. RACS Surgical News April 2018. 19(3). 44-46
- Medicare Benefits Taskforce Review - Report From Orthopaedic Clinical Committee.