Knee Keyhole Surgical Operation

A new paper neatly nails the problem with the conventional wisdom surrounding arthroscopy: we’ve been throwing the baby out with the bathwater, says Jon Smith.

If there’s one emotion you can’t help but read into a recent editorial from esteemed orthopaedic surgeon Robert LaPrade and others entitled Knee arthroscopy: evidence for a targeted approach, it’s frustration. To that you can add more than a little defensiveness. Why is that?

 

What is knee arthroscopy?

Arthroscopy is keyhole surgery. Through a small incision, a knee surgeon inserts a tool to enable them to view the problem and fix it. You can see that process in action in this video by my YKC colleague Dave Duffy.

Knee arthroscopy can be extremely effective in certain instances. Removing loose fragments floating around in the knee – as seen in the video – is a perfect example of that.

But not all arthroscopies are good.

A decade or so ago, evidence began to appear that ‘knee washouts’, that is, arthroscopies carried out to relieve symptoms of osteoarthritis, weren’t effective. Similarly diagnostic arthroscopies, that is, keyhole surgery carried out to identify the causes of a problem, also began to fall out of favour.

As this report illustrated, the numbers of such arthroscopies decreased dramatically. The conventional wisdom became that ‘arthroscopy was bad.’ And the idea stuck. It stuck so well that insurers stopped paying for it (or paying as much for it) and the NHS ceased its use on the basis that greater bang for the taxpayer’s buck was available elsewhere. All of which further exacerbated its decline.

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The case for targeted arthroscopies

But as LaPrade and others’ editorial notes, “oversimplification can be misleading”. Such oversimplification has led to arthroscopy being generally dismissed – which effectively throws the baby out with the bathwater.

Arthroscopies can have value. In removing loose bodies or resolving meniscal tears and chondral lesions they can be entirely effective. But such arthroscopies need to be targeted. By targeted we mean that, before surgery, a surgeon needs to build a clinical picture using the patient’s symptoms and signs along with the X-ray or (more usually) MRI scan. That gives the surgeon a clear target to aim for, making the arthroscopy an effective tool to resolve the problem.

That approach is backed by the British Association for Surgery of the Knee (BASK), whose guidance on meniscal tears shows a very clear role for arthroscopy and when to employ it. It’s an extremely simple and useful guide for surgeons and one that YKC’s surgeons support and use.

So if you feel something moving around in your knee – or feel the knee catching or locking – we’ll need to build a clear picture of the issue first. But subject to the results of that diagnosis, a knee arthroscopy may still be the right way to proceed.

Talk to us about your knee pain now or phone us on 03453 052 579.

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Jon Smith

Jon Smith

Private appointments weekly at Nuffield Hospital Leeds

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Email Jon

js@yorkshirekneeclinic.com

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