A recently published research report has received attention this past week in US news outlets. The study, conducted in Finland and published in the New England Journal of Medicine, was centered on a very common orthopedic condition: meniscal tears in the knee. This clinical trial took a sample of people diagnosed with meniscal tears, and randomly assigned them to either an arthroscopic surgery group or a sham arthroscopic surgical group. The surgical group underwent a repair procedure; the sham group had only arthroscopic incisions introduced to their knee, but did not have surgery. The researchers found that after a period of one year, there were no significant differences between the groups with regard to knee pain, and their level of satisfaction with their treatment.
The findings of this study are consistent with other similar studies that have been done with patients undergoing arthroscopic surgical procedures for knee osteoarthritis. Randomized control trials of this nature, however, are few are far between. They are hard to conduct due to ethical issues surrounding use of human subjects in research, and the guiding principle: “do no harm”.
Yet, studies like this do inform the health care community about the potential benefits, or lack thereof, of certain surgical procedures for certain subgroups of people. And they highlight a lack of knowledge about the appropriateness and efficacy of many elective orthopedic surgical procedures. In many cases, including joint replacement procedures, we just do not know enough about who really benefits from these procedures in the long-run.
For any elective orthopedic procedure, the decision-making process should be comprehensive. In addition to information about the specific type of pathology involved and the surgical options, factors such as the person’s age, level of function, types of activity they like/need to perform, and personal goals should be taken into consideration. All treatment options should be on the table. Physical therapy management can be an alternative choice for many orthopedic conditions. Also, when individuals are considering surgery for an orthopedic condition, consultation with a physical therapist can be helpful.
Recent advances in orthopedic surgical procedures have improved the lives of many. Depending upon the specific pathology, there will be times when surgery is clearly the best option. But there will be other times when conservative care is the best option. The most important message here is that informed decision-making is the best way to insure optimal care for a variety of orthopedic problems.
Marcia Miller Spoto, PT, DC, OCS