Surgery to remove partial meniscal tears does not result in better knee function than medical treatment and physical therapy alone. Arthroscopic partial meniscectomies are one of the most common orthopedic procedures performed each year in the United States at a cost of $4 billion. These results of this study in the December 26, 2013 issue of the New England Journal of Medicine raise serious questions about the cost effectiveness of this surgical treatment and the ethics of using it as a future treatment.
The study looked at 146 patients who had knee symptoms consistent with a degenerative medial meniscal tear but no arthritis. Half of them underwent surgical removal of the portion the meniscus that was damaged and the other half underwent a sham operation that lasted the same time and with the same appearances and feel of a real operation. After one year, both groups were compared for knee function, and the results were the same. While the outcomes may be similar for surgery and non-surgical treatment, the cost and risk of serious complications with surgical intervention are very different and with much higher.
As discussed in Health Care Costs Driven by Self-Dealing, the best treatment the physician can provide is not always the best treatment for the patient. Arthroscopic meniscectomy for partial meniscal tears creates a conflict of interest in so far as it is profitable for the surgeon to operate while increasing risk for the patient without any demonstrable clinical advantage. In light of the lack of evidence supporting arthroscopic partial meniscectomy, its continued use for partial tears in the absence of other pathology creates an unwarranted risk of injury and cost for patients.