RATES of non-reconstructive, non-reparative arthroscopic knee procedures in people over 50 years of age have declined over the past 10 years, according to the authors of a research letter published in the Medical Journal of Australia.
Professor Christopher Vertullo, a knee surgeon, Director of Knee Research Australia, and current President of the Knee Society Australia, and colleagues extracted data on arthroscopic knee procedures for patients aged 50 years or more from July 2008 to June 2018 from the Australian Institute of Health and Welfare database.
“A total of 512 214 arthroscopic knee operations were performed during the 10-year study period,” Vertullo and colleagues found. “The incidence increased from 756.2 operations per 100 000 people in 2008–09 to a peak 794.7 per 100 000 people in 2011–12, a [statistically non-significant] 5% rise. The rate of knee arthroscopies then declined to 483.5 operations per 100 000 people in 2017–18.”
The publication of low bias randomised controlled trials over the past 6 years had contributed to the drop in procedure rates, the authors wrote.
“The first reports that outcomes of partial medial meniscectomy in degenerative non-obstructive tears were not superior to non-operative management were published in 2013,” Vertullo and colleagues wrote.
“The reduction in arthroscopic procedure rates we found began shortly after the publication of these articles and ensuing medical society position statements. Additionally, the popularity of meniscal repair has increased, perhaps because of reports of negative long-term sequelae of meniscectomy and the cost-effectiveness of meniscal repair when appropriate.”
The authors concluded that “the role of primary care is vital, with recent clinical guidelines recommending that middle-aged patients with uncomplicated atraumatic knee pain should be managed by their general practitioner”.
- Cate Swannell