Commentary: Ho Hum, Most Knee Meniscus Operations Are Unnecessary. What’s New?

Yet another study drops a bomb on the credibility of modern medicine over needless knee operations, but it’s business as usual in outpatient surgical centers today.

So does the realization most knee surgeries for a torn meniscus are unnecessary going to cause orthopedists to cease doing these operations? The most recent published study shows three out of four knee operations for a torn meniscus respond well to physical therapy and no surgery is needed. [British Medical Journal July 20, 2016]

Recognize, operations on the knee for a torn meniscus are the second most frequent surgical procedure performed behind cataract operations in the U.S.  Over 1 million are performed in the U.S. alone each year.

The recent headline news report over needless knee operations is not new.  So-called keyhole (arthroscopic) knee surgery has been reported to be no better than placebo for some time now. [Huffington Post May 2015]  The first report that arthroscopic knee surgery is no better than placebo was published over a decade ago.

It turns out, meniscus tears are common even among adults with no knee pain.   About 35% of adults over age 50 are walking around with meniscus tears in their knees.

These knee operations cost $4 billion a year.  Do you think orthopedists are going to take that pay cut laying down?  Hey, according to one report, since the initial report of needless knee operations was published over a decade ago, knee operations have declined but surgical procedures for meniscal tears have increased by 50%!  It took a obstetrician to report this.  No orthopedist, saved for a few retired ones, dare to reveal all this. [KevinMD.com]

Will billings by outpatient centers for this operations be denied by insurance carriers?  Will State medical boards sanction any physicians for performing needless knee operations?  Don’t count on it.  Health insurers have had a decade to do something about this and have failed.

Orthopedists tend to prefer injection of blood plasma over injection of hyaluronic acid (HA) for meniscal tears, with HA injections performed for temporary treatment of arthritis (wear and tear) of the spongy parts of the knee.  However, in the animal lab, HA injections were demonstrated to improve the healing process in meniscus tears. [Physical Therapy In Sport May 2013]  HA injections have been shown to reduce pain and tenderness following knee surgery. [American Journal Orthopedics Dec 2009]

While orthopedists typically claim oral hyaluronic acid is not well absorbed, an online patient survey published at WebMD of all places, reveals oral HA is quite effective for many people with knee problems including meniscus tears. [WebMD]

A study showing the effectiveness of oral HA for knee arthritis has been published.  That study cited five prior studies that also confirmed the effectiveness of oral HA for knee problems.  X-ray evidence of improvement confirmed oral HA is of value for knee pathology.  Indeed, oral HA is absorbed.  The positive effects are more demonstrative in younger subjects.  [Scientific World Journal 2012]

The Cleveland Clinic concludes oral hyaluronic acid “shows promise for knee pain.” [Cleveland Clinic]

What if insurers required a 6-month trial of oral HA before any consideration of knee surgery?

Bottom line: nothing is going to change.  Patients with meniscus tears in their knees are going to continue to be conned into surgery because it is minimally invasive and covered by insurance.

There are about 25,000 orthopedists in the U.S.  Reduce the number of knee operations for a partially-torn meniscus by 75% to save $3 billion a year and you take $120,000 of income out of orthopedists pockets annually.  Oral HA doesn’t generate income for joint surgeons.  All of American medicine opts for treatment that generates the highest reimbursement.

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