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Arthroscopy on the Decline

Take a look at this journal cover from the most recent British Journal of Sports Medicine in November 2020.

The cartoon depicts older orthopedic surgeons abiding by the guidelines from the society of arthroscopy. This is back when arthroscopy was king. Today, it continues to be a large source of revenue for orthopedic surgeons.

The cartoon also shows younger physicians gravitating towards “EBM.” EBM stands for evidence based medicine. This is the gold standard we should all be striving for.

This provocative journal cover stems from two recent publications in the British Journal of Sports Medicine.

  1. This study compared arthroscopic partial meniscectomy to sham surgery for the treatment of degenerative meniscus tears. I’ve covered this topic here. Long story short: there is no difference in outcomes between partial meniscectomy and sham surgery. In fact, the surgical group had increased rates of arthritis compared to the sham group.

  2. This study compared arthroscopic subacromial decompression to sham surgery for the treatment of rotator cuff impingement. Again, there is no difference between the surgical group and sham surgery.

The authors at the BJSM write:

“You should not feel pressured into referring patients for a surgical opinion unless you think the time may be right for a certain subgroup of patients to consult a surgeon.”

The evidence is moving away from arthroscopic surgery. Conservative measures such as exercise therapy do just as good and in some cases better than surgery. There is also a growing amount of evidence for orthobiologics and platelet rich plasma. These are excellent options which can help patients avoid surgery.

Consult with a primary care sports medicine physician to learn more about nonsurgical treatment options.


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