For thousands of Americans with knee pain, surgery may not be the answer and could worsen their condition.
A decade-long study in the New England Journal of Medicine found patients who had arthroscopic surgery to trim degenerative cartilage tears saw no improvement—and often fared worse—than those who received a placebo procedure. The work, led by Finnish orthopedist Teppo Järvinen, revealed surgery was tied to faster osteoarthritis progression and more follow-up operations, frequently resulting in total knee replacements.
Surgery’s limited benefit
The study tracked two groups: one that underwent the actual procedure and another that received a “sham” surgery involving only a skin incision. Both reported similar pain levels, but the surgery group faced greater joint damage. Järvinen, who heads the Finnish Centre for Evidence-Based Orthopaedics, described the results as striking.
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“I don’t know how anyone could justify this procedure,” he said. “The data clearly shows these patients experience more pain and poorer outcomes.”
The findings focus on middle-aged and older adults with degenerative tears, not acute injuries. MRIs often detect such tears in people over 50, though many are painless, reflecting normal wear rather than a direct source of discomfort.
Despite mounting evidence against the procedure, arthroscopic knee surgery remains widespread in the U.S., though rates have fallen. A review of commercial insurance claims showed meniscus surgeries declined by about 4% each year from 2010 to 2020, with most performed on women and patients in their 50s. Medicare records indicate a sharper drop, from 169,000 procedures in 2014 to 91,000 in 2024.
Guidelines shift, but practice lags
Orthopedic groups in Europe and the U.S. now advise physical therapy as the primary treatment, reserving surgery for cases where other methods fail. Yet regional differences persist. Medicare patients in the South, for instance, undergo the procedure far more often than those in the Northeast.
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Robert Brophy, who directs the Orthopaedic Clinical Research Center at Washington University in St. Louis, noted the inconsistency. “The evidence supports more careful use of this surgery for these patients,” he said. “But some still benefit.”
The recommended approach starts with physical therapy and, if necessary, weight loss. Steroid injections offer temporary relief, though stem cell and plasma treatments lack strong evidence and are rarely covered. A newer option, meniscus repair, is usually limited to younger patients with clean, acute tears.
When other treatments fail, knee replacement becomes an option for hospitals and surgeons. Yet for most patients with degenerative knee pain, the best approach is often the most straightforward: time, movement, and patience.
