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Arthroscopy to treat osteoarthritis of the knee?

Rachelle Buchbinder and Ian A Harris
Med J Aust 2012; 197 (7): . || doi: 10.5694/mja12.11201
Published online: 1 October 2012

Changing clinician beliefs and behaviour in response to credible evidence of lack of treatment efficacy remains highly challenging

Arthroscopy is commonly used to treat people with knee pain due to osteoarthritis. However, data collected from randomised controlled trials over the past two decades have provided compelling evidence that, in general, arthroscopic treatment comprising debridement and lavage is no more effective than placebo surgery or non-operative alternatives,1,2 and observational data suggest that it may mean a joint replacement is needed sooner.3


  • 1 Monash Department of Clinical Epidemiology, Cabrini Health, Melbourne, VIC.
  • 2 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC.
  • 3 South Western Sydney Clinical School, University of New South Wales, Sydney, NSW.
  • 4 Whitlam Orthopaedic Research Centre, Sydney, NSW.



Competing interests:

No relevant disclosures.

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  • 2. Reichenbach S, Rutjes AW, Nüesch E, et al. Joint lavage for osteoarthritis of the knee. Cochrane Database Syst Rev 2010; (2): CD007320.
  • 3. Hawker G, Guan J, Judge A, Dieppe P. Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement. J Bone Joint Surg Am 2008; 90: 2337-2345.
  • 4. Bohensky M, Sundararajan V, Andrianopoulos N, et al. Trends in elective knee arthroscopies in a population-based cohort, 2000–2009. Med J Aust 2012; 197: 399-403. <MJA full text>
  • 5. Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347: 81-88.
  • 6. Kirkley A, Birmingham TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2008; 359: 1097-1107.
  • 7. Herrlin S, Hållander M, Wange P, et al. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 2007; 15: 393-401.
  • 8. Festinger L. A theory of cognitive dissonance. California: Stanford University Press, 1957.
  • 9. Kim S, Bosque J, Meehan JP, et al. Increase in outpatient knee arthroscopy in the United States: a comparison of national surveys of ambulatory surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93: 994-1000.
  • 10. Potts A, Harrast JJ, Harner CD, et al. Practice patterns for arthroscopy of osteoarthritis of the knee in the United States. Am J Sports Med 2012; 40: 1247-1251.

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