Knee Pain? Ragged Cartilage? Research Suggests Surgery’s Not the Best Answer
Thousands of Americans undergoing a common knee surgery may find themselves facing worse outcomes rather than relief. Recent research has revealed troubling insights about arthroscopic knee surgery, specifically the procedure aimed at trimming degenerative cartilage tears. A study that tracked patients for a decade found that those who underwent the surgery experienced little to no benefit, with some even developing accelerated osteoarthritis and higher rates of reoperation, often leading to total knee replacements.
Teppo Järvinen, an orthopedist and head of the Finnish Centre for Evidence-Based Orthopaedics, expressed his concerns, stating, “I don’t know how I would defend this procedure at all. What has been shown dramatically is that patients who have this procedure have more pain — they do worse. All the scores pointed in the same direction.”
The Finnish study, published in April in the New England Journal of Medicine, is the first to indicate that many patients are left worse off after the surgery. Although the study was small, Järvinen noted that it focused on patients “most likely to benefit.” Importantly, the findings do not pertain to cartilage tears resulting from acute injuries; the subjects were middle-aged or older individuals experiencing knee pain with MRI-confirmed cartilage tears.
Over the past decade, evidence has consistently shown that arthroscopic knee surgery to trim torn, degenerative cartilage does not yield better results than physical therapy. In Finland, the rate of such surgeries has plummeted by 90%, while the decline in the U.S. has been much slower.
A study analyzing commercial claims in the U.S. found that the number of meniscus surgeries decreased by about 4% annually from 2010 to 2020, with most procedures performed on women and patients in their 50s. In the traditional Medicare fee-for-service program, the number of procedures has also steadily declined, from approximately 169,000 in 2014 to 91,000 in 2024, according to federal data. These figures do not account for beneficiaries in Medicare Advantage plans, which cover more than half of Medicare enrollees.
Prior studies have shown that such cartilage tears are common in individuals over 50, often resulting from wear and tear and frequently not causing pain. Järvinen emphasized, “Nothing supports the idea that a patient’s pain comes from the meniscus.”
Robert Brophy, director of the Orthopaedic Clinical Research Center at Washington University in St. Louis, acknowledged the growing evidence for a more selective approach to this surgery. However, he noted that many patients still do benefit from it. Current practices among orthopedic surgeons vary widely, with data indicating that surgery for meniscus tears is significantly more common in the South than in the Northeast.
A consensus statement released by a large committee of orthopedic societies in Europe and the U.S. last June highlighted that “degenerative meniscus lesions can be treated with comparable results with either non-operative (including physical therapy) or surgical approaches.” The statement recommended trying physical therapy before opting for surgery, although it still endorsed the operation.
Orthopedic specialty societies have been advocating for a campaign called the Save the Meniscus Society, which aims to promote long-term knee health through non-surgical treatments, surgical repairs, and other therapies.
In the U.S., the Relative Value Scale Update Committee (RUC), composed largely of specialists, determines physician payments. There have been discussions about changing this structure, but it remains unclear how that could be achieved, given that the AMA owns the billing codes used to calculate patient charges.
Arthroscopic knee surgery typically lasts between 30 to 60 minutes, with patients spending a few hours recovering afterward. Medicare reimburses an average of $2,159 to $3,875 for the procedure, depending on the location, with patients responsible for 20% of the fee. Commercial insurers often pay significantly more, and the total costs can vary widely based on additional factors, such as the involvement of multiple doctors.
Historically, treatment for cartilage tears has evolved significantly. Fifty years ago, the standard approach was to remove the entire piece of cartilage, as it was considered a vestigial tissue. Today, the first-line therapy for painful knees with degenerative tears typically involves physical therapy and, for some, weight loss. Arthroscopic surgery is considered based on the surgeon’s perspective on its effectiveness.
In addition to surgery, various injections are available. Steroid injections have shown short-term benefits, while stem cell and plasma-rich protein injections are controversial and often not covered by insurance due to inconclusive evidence regarding their efficacy.
As orthopedic surgeons move away from trimming meniscus tears, they are increasingly highlighting a newer procedure that involves sewing the torn cartilage back together. However, this option is generally reserved for patients under 50 with acute injuries and clean tears, leaving uncertainty about which patients might truly benefit.
When conservative treatments fail, knee replacement surgery remains a prevalent option, often generating significant revenue for hospitals and physicians.
Thousands of Americans undergoing a common knee surgery may find themselves facing worse outcomes rather than relief. Recent research has revealed troubling insights about arthroscopic knee surgery, specifically the procedure aimed at trimming degenerative cartilage tears. A study that tracked patients for a decade found that those who underwent the surgery experienced little to no benefit, with some even developing accelerated osteoarthritis and higher rates of reoperation, often leading to total knee replacements.
Teppo Järvinen, an orthopedist and head of the Finnish Centre for Evidence-Based Orthopaedics, expressed his concerns, stating, “I don’t know how I would defend this procedure at all. What has been shown dramatically is that patients who have this procedure have more pain — they do worse. All the scores pointed in the same direction.”
The Finnish study, published in April in the New England Journal of Medicine, is the first to indicate that many patients are left worse off after the surgery. Although the study was small, Järvinen noted that it focused on patients “most likely to benefit.” Importantly, the findings do not pertain to cartilage tears resulting from acute injuries; the subjects were middle-aged or older individuals experiencing knee pain with MRI-confirmed cartilage tears.
Over the past decade, evidence has consistently shown that arthroscopic knee surgery to trim torn, degenerative cartilage does not yield better results than physical therapy. In Finland, the rate of such surgeries has plummeted by 90%, while the decline in the U.S. has been much slower.
A study analyzing commercial claims in the U.S. found that the number of meniscus surgeries decreased by about 4% annually from 2010 to 2020, with most procedures performed on women and patients in their 50s. In the traditional Medicare fee-for-service program, the number of procedures has also steadily declined, from approximately 169,000 in 2014 to 91,000 in 2024, according to federal data. These figures do not account for beneficiaries in Medicare Advantage plans, which cover more than half of Medicare enrollees.
Prior studies have shown that such cartilage tears are common in individuals over 50, often resulting from wear and tear and frequently not causing pain. Järvinen emphasized, “Nothing supports the idea that a patient’s pain comes from the meniscus.”
Robert Brophy, director of the Orthopaedic Clinical Research Center at Washington University in St. Louis, acknowledged the growing evidence for a more selective approach to this surgery. However, he noted that many patients still do benefit from it. Current practices among orthopedic surgeons vary widely, with data indicating that surgery for meniscus tears is significantly more common in the South than in the Northeast.
A consensus statement released by a large committee of orthopedic societies in Europe and the U.S. last June highlighted that “degenerative meniscus lesions can be treated with comparable results with either non-operative (including physical therapy) or surgical approaches.” The statement recommended trying physical therapy before opting for surgery, although it still endorsed the operation.
Orthopedic specialty societies have been advocating for a campaign called the Save the Meniscus Society, which aims to promote long-term knee health through non-surgical treatments, surgical repairs, and other therapies.
In the U.S., the Relative Value Scale Update Committee (RUC), composed largely of specialists, determines physician payments. There have been discussions about changing this structure, but it remains unclear how that could be achieved, given that the AMA owns the billing codes used to calculate patient charges.
Arthroscopic knee surgery typically lasts between 30 to 60 minutes, with patients spending a few hours recovering afterward. Medicare reimburses an average of $2,159 to $3,875 for the procedure, depending on the location, with patients responsible for 20% of the fee. Commercial insurers often pay significantly more, and the total costs can vary widely based on additional factors, such as the involvement of multiple doctors.
Historically, treatment for cartilage tears has evolved significantly. Fifty years ago, the standard approach was to remove the entire piece of cartilage, as it was considered a vestigial tissue. Today, the first-line therapy for painful knees with degenerative tears typically involves physical therapy and, for some, weight loss. Arthroscopic surgery is considered based on the surgeon’s perspective on its effectiveness.
In addition to surgery, various injections are available. Steroid injections have shown short-term benefits, while stem cell and plasma-rich protein injections are controversial and often not covered by insurance due to inconclusive evidence regarding their efficacy.
As orthopedic surgeons move away from trimming meniscus tears, they are increasingly highlighting a newer procedure that involves sewing the torn cartilage back together. However, this option is generally reserved for patients under 50 with acute injuries and clean tears, leaving uncertainty about which patients might truly benefit.
When conservative treatments fail, knee replacement surgery remains a prevalent option, often generating significant revenue for hospitals and physicians.
