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Exercise therapy is more beneficial than arthroscopic surgery in older knee patients

Arthroscopic surgery for knee pain in middle-aged or older patients has an ‘inconsequential’ benefit, according to a review of the evidence.

Arthroscopic surgery in middle-aged and older patients is ‘difficult to justify’

Picture credit: SPL

Researchers reviewed the results of 18 studies on the benefits and harms of arthroscopic surgery for knee pain in patients with and without osteoarthritis compared with control treatments ranging from placebo surgery to exercise. The average age of patients ranged from 48 to 63 years, with follow-up time between three and 24 months.

Overall, surgery was associated with a small but significant effect on pain at three and six months, but no longer, compared with control treatments. No significant benefit on physical function was found.

A further nine studies reporting on harms found that, although rare, deep vein thrombosis was the most frequently reported adverse event, followed by infection, pulmonary embolism and death.

The researchers point out that the benefit from arthroscopy was ‘markedly smaller than that seen from exercise therapy’. They conclude that the findings do not support arthroscopic surgery as a treatment for this group of patients.

In a related editorial (www.bmj.com/cgi/doi/10.1136/bmj.h2983), Andy Carr from the Oxford University Institute of Musculoskeletal Sciences, says: ‘It is difficult to justify a procedure with the potential for serious harm, even if it is rare, when that procedure offers patients no more benefit than placebo.’

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