What is the recommended treatment and recovery process for arthroscopic surgery?

Arthroscopic Surgery for Degenerative Knee Disease: Treatment and Recovery

Conservative management is strongly recommended over arthroscopic surgery for patients with degenerative knee disease, as arthroscopic knee surgery does not provide clinically meaningful improvements in pain, function, or quality of life compared to non-surgical approaches. 1

Understanding Degenerative Knee Disease

Degenerative knee disease is an inclusive term that encompasses:

• Patients with knee pain, particularly those >35 years old
• Conditions with or without imaging evidence of osteoarthritis
• Meniscus tears
• Mechanical symptoms (locking, clicking)
• Acute or subacute onset of symptoms 1

Treatment Algorithm

First-Line Treatments (Recommended)

1. Conservative Management:
   • Exercise therapy/physical therapy
   • Weight loss for overweight patients
   • Oral or topical pain medications (NSAIDs, acetaminophen)
   • Intra-articular corticosteroid injections

Not Recommended

• Arthroscopic surgery including:
  • Arthroscopic debridement
  • Arthroscopic partial meniscectomy
  • Arthroscopic lavage

Evidence Against Arthroscopic Surgery

The 2017 BMJ clinical practice guideline strongly recommends against arthroscopic knee surgery for degenerative knee disease based on high-quality evidence showing:

• No clinically meaningful improvement in long-term pain or function compared to conservative management 1
• Less than 15% of patients experience small, short-term improvements at 3 months that are not sustained at 1 year 1
• Potential harms including pain, swelling, and rare but serious complications like infection and venous thromboembolism 1

Despite being commonly performed (over 2 million procedures annually worldwide), arthroscopic procedures for degenerative knee disease have not demonstrated meaningful benefits over non-surgical approaches 1.

Recovery Process When Surgery Is Performed

If arthroscopic surgery is performed despite recommendations against it:

• Recovery typically takes 2-6 weeks 1
• At least 1-2 weeks off work is required, depending on job demands 1
• Rehabilitation protocols often include:
  • Progressive weight-bearing
  • Range of motion exercises
  • Strengthening exercises
  • Gradual return to activities

Common Pitfalls to Avoid

1. Overreliance on imaging findings: Meniscal tears and other abnormalities are common in asymptomatic individuals and may not be the source of pain
2. Assuming mechanical symptoms require surgery: Evidence does not support arthroscopy even in patients with mechanical symptoms 1
3. Underutilization of conservative treatments: Only 6-10% of patients receive all recommended non-surgical treatments before surgery 2
4. Neglecting weight management: Dietary therapy is particularly underutilized, with only 11% of overweight and 30% of obese patients receiving this intervention 2

Special Considerations

For patients with severe degenerative knee disease who have failed conservative management, total knee replacement (not arthroscopy) is the definitive surgical treatment 1.

While some research suggests that arthroscopic procedures may have better outcomes for specific conditions like dorsal impingement syndrome 3, the evidence for degenerative knee disease consistently shows no benefit over conservative management.