Arthroscopic Surgery no better than Conservative Therapies in Degenerative Knee Disease

Many studies show that conservative therapy, including physical therapy, is not inferior to arthroscopy for patients with knee osteoarthritis (e.g., NEJM JW Gen Med Aug 1, 2015, and BMJ 2015; 350:274). For this report, investigators reviewed 13 randomized, controlled trials and 12 observational studies in which arthroscopic surgery was compared with conservative management (including sham surgery) in patients with degenerative knee disease. Degenerative knee disease was defined as persistent knee pain, with or without osteoarthritis, that affects a patient’s quality of life. Arthroscopic procedures were defined as debridement, partial meniscectomy, or both.

Key Points

• Patients who undergo failed conservative therapies often erroneously attribute marked improvements after surgery to the procedure itself instead of to natural improvement over time or to placebo effects.


• In <15% of participants, arthroscopic surgery resulted in small or very small improvement in pain or function at 3 months after surgery — this benefit was not sustained at 1 year.


• During follow-up of at least 2 years, pain and function after arthroscopy were similar to pain and function after conservative therapy.


• The guideline panel strongly recommends against the use of arthroscopy in nearly all patients who have degenerative knee disease, with or without imaging evidence of osteoarthritis, mechanical symptoms, or sudden onset of symptoms.