27 Dec Hi Everyone
This is Peter Borten. I’m a co-owner of the Dragontree and I practice acupuncture, herbal medicine, and nutrition here. I will be blogging regularly on medical topics, mostly pertaining to alternative medicine.
A big part of my practice is the treatment of pain and injuries, of which knee injuries comprise a significant portion. Many of my patients with chronic knee problems have had one or more surgeries. I can tell the older surgeries by the massive telltale scars, sometimes six inches long, used to open up the whole joint. More recent surgeries usually leave just a few small scars about the size of a pencil eraser. These are the mark of arthroscopic surgery. One hole is used to insert a video camera (the arthroscope) which lets the surgeon see inside the joint. One or more additional holes are used to insert small surgical instruments. Arthroscopic surgery has generally been hailed as a huge leap forward in knee surgery.
But a recent study in the New England Journal of Medicine (http://content.nejm.org/cgi/content/short/359/11/1097) found that arthroscopic knee surgery for osteoarthritis (that is, garden variety “wear and tear” deterioration and pain of the knee) offered no additional benefit over standard care (physical and medical therapies). Then a Swedish study published last week (http://www.medscape.com/viewarticle/585235?src=mp&spon=17&uac=117747BV) found that arthroscopic knee surgeries to repair damage of the ACL (anterior cruciate ligament) were also of questionable benefit. ACL ruptures are one of the most common sport injuries. While the knee is usually stable and functional even with a complete tear of this ligament, the thinking has been that without reconstructive surgery it will deteriorate, leading to weak muscles and arthritis later. But this study showed that 2-5 years after the injury, people who got surgery had comparable levels of muscle strength, function, and pain as those who hadn’t gotten surgery.