Cited in the New York Times July 11, 2002, Arthroscopic surgery on the knee for the symptoms of pain and stiffness due to osteoarthritis is performed on at least 225,000 middle-aged and older Americans each year at a cost of more than a billion dollars to Medicare, the Department of Veterans Affairs and private insurers. When medical conservative treatment does not relieve osteoarthritic knee pain, procedures such as arthroscopic lavage or debridement are often used. Over 650,000 such procedures are performed every year at a cost of about $5,000 each. As more and more people search for alternative therapies such as chiropractic care, this research has much importance.
The New England Journal of Medicine reported on the results of a randomized, placebo-controlled trial to evaluate the efficacy of arthroscopy for osteoarthritis of the knee. 180 patients with osteoarthritis of the knee were randomly assigned to receive arthroscopic debridement, arthroscopic lavage or placebo surgery. The placebo group received only skin incisions and underwent a simulated arthroscopic operation but the arthroscope was not inserted. The patients in the study were informed that they might not receive actual surgery. The placebo group received a short-acting intravenous tranquilizer while the surgical group received the standard general anesthesia. The patients that received the placebo were kept in the operating room for the same amount of time as the surgical patients, and spent the night after the procedure in the hospital being cared for by nurses who "were unaware of the treatment-group assignment."
All patients received the same medical walking aids, graduated exercise and analgesics. For placebo patients, during the "operation" the surgeon asked for all instruments and manipulated the knee as if arthroscopy were being performed. Even saline was splashed to simulate the sounds of lavage in case the patient was partly conscious. The surgical patients were lavaged with at least ten liters of fluid to flush and cleanse the knee of painful debris and inflammatory enzymes. Torn portions of meniscus were removed, and the remaining meniscus was smoothed to a firm, stable rim. Rough articular cartilage was shaved, loose debris was removed, and any bone spurs on the tibial spine that blocked full extension were also shaved smooth.
Only one surgeon was used, who did not know the procedure until he opened an envelope at the time of the operation. The surgeon was board-certified; trained in arthroscopy and sports medicine (fellowships); in practice for 10 years in an academic medical center; and currently the orthopedic surgeon for a National Basketball Association team. He was also the physician for the men's and women's U.S. Olympic basketball teams in 1996.
The patients were assessed regularly during and after the procedure. The authors of the study even determined whether there may have been some clinically important benefits they may have missed in the surgical group due to their small sample size. For the comparisons they questioned, the 95 percent confidence intervals did not contain any important differences, indicating that there was not a clinically important improvement the study had simply failed to detect. The final conclusion of the study was "the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure."
A growing number of people are looking for alternative therapies for their knee problems and back pain. New Century Spine Centers in San Diego 92108 regularly treats sports injuries and back problems. Some common injuries are meniscal injuries, sports injuries, muscle spasms, sciatica, and more. Some of the newest treatments options include active release therapy, cold laser therapy, activator methods, palmer technique, spinal decompression and chiropractic care by chiropractors.
