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By Timothy Cocks Science and the world 19 Jun 2015

Editorial published a few days ago in the BMJ:

Overused, ineffective, and potentially harmful

“The most frequent indication for knee arthroscopy is degenerative joint disease in middle aged and older patients. Each year, more than 700 000 knee arthroscopies are done in the United States and 150 000 in the United Kingdom. Magnetic resonance imaging evidence of meniscal abnormality, osteophytes, cartilage damage, and bone marrow lesions is often present. All these imaging abnormalities are common in the general population and are often asymptomatic…. 

A linked paper by Thorlund and colleagues (doi:10.1136/bmj.h2747) adds substantially to the debate by systematically reviewing all the evidence on the benefits and harms of arthroscopic knee surgery for middle aged and older adults with knee pain and degenerative knee disease.5 The authors report that the small benefit seen after arthroscopic surgery of the knee is short lived and disappears within one to two years.

One thing is clear from all randomised trials: patients improve after arthroscopy. This is in line with surgeons’ own observations and with evidence from uncontrolled observational studies. However, in robust and bias-free trials that use placebo controls, active treatment works no better than control treatment. In response, leaders of the arthroscopic surgery community have asserted that patients who participate in placebo controlled trials “may not be of entirely sound mind”

Overall an interesting read, especially that take on participants in placebo controlled trials.

-Tim Cocks


  1. There is similar poor evidence for facet joint injections and denervations.However there is a club in medicine and it’s very protective of itself and this is the world over.
    Evidence based medicine should apply to all,especially when operative techniques carry much higher risks

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