When treating meniscal tears -- one of the most common orthopaedic surgical procedures -- surgeons also have clipped and smoothed any dislodged cartilage they found in the belief it was helping patients. But the new study finds that practice does not benefit the patient. Patients who did not have dislodged cartilage removed recovered faster, with less pain, and ended up a year later with identical results.
"Those with less surgery got better faster in comparison with the people we did more surgery on," says Leslie J. Bisson, professor and chair in the Department of Orthopaedics in the Jacobs School of Medicine and Biomedical Sciences and lead author of the study.
The finding was so surprising that an editor at The Journal of Bone & Joint Surgery, which published the study, also published a commentary: "The conclusion that unstable cartilage lesions do not need debridement could have a dramatic impact on practice management, save health care dollars, and improve early patient outcomes."
The American Academy of Orthopaedic Surgeons also distributed the study in its weekly collection of papers of note.
Doctors check for arthritis -- the tearing or dislodgement of articular cartilage called chondral lesions -- using X-rays when they are preparing to treat a meniscus in the knee. But sometimes low-level arthritis is not visible, and doctors find it only when they are inside the knee, Bisson explains. At that point, doctors always have opted to clip and smooth any loose cartilage.
Better early outcomes
The study followed 190 patients who were having arthroscopic partial meniscectomies (APM). Of those, 98 received debridement of the damaged cartilage and 92 did not receive debridement. Both groups had the same results one year after surgery, but prior to that, the group without debridement had less pain and better function than those who had the cartilage trimmed and smoothed.
"That was very surprising to us," Bisson says. "We are bringing those patients back and doing X-rays at five years to see if it made a difference in their arthritis."
In the meantime, surgeons at UBMD Orthopaedics & Sports Medicine, where Bisson and the other doctors involved in the study practice, are no longer debriding knee cartilage when repairing meniscal tears.
"That’s a marked change. In my group, with five sports medicine doctors, we do close to 1,000 APMs a year," he says.
Middle age injury