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Arthroscopy for Arthritis, When is it Appropriate? by John Post,MD


“I’ll take any risk to tie back the hands of time.” Styx

Triathlon covers all walks of life and all age groups. It’s addictive, and it’s cumulative training, plus getting older, can have deleterious effects on the body. Why do we see fewer and fewer folks in the older age groups? It’s not ’cause they’re busy playing Mahjong at the Senior Center. As we begin to “wear out” arthritis can become part of the picture and we reach for the cure so we can continue training and racing.

When the knees start to go (and we’re not talking about the patient with some type of inflammatory arthritis here), many remedies can be recommended and be helpful including rest, or decreased training load anyway. Some variety of braces or sleeves are often of benefit. Therapy of one form or another with oral meds and injections have been known to be helpful in specific cases. And what about surgery?

We have become so accustomed to it that more than once I’ve had a patient refer to arthroscopy of the knee as “band-aid surgery.” Honestly. They have no more respect for undergoing and anesthetic and surgical procedure with all of the attendant potential risks and complications than that. Please, only consider surgery when non-surgical means have been exhausted and the benefits outweigh the risks for you.

So which patients with a deteriorating knee can a scope help? Primarily those with some type of mechanical symptom, catching, snapping, locking, that sort of thing. Being under 50 helps as does normal alignment, not smoking, not being over weight, shorter duration of symptoms, and hopefully minimal changes on x-ray. These are standing, weight bearing x-rays taken of both knees to compare the painful and non-painful knees. We’re not talking about an MRI here. When the athlete has arthroscopy to “clean up the arthritis,” the potential for long term success is relatively low.  This may be the take home lesson of this post.

I taught a course to about 200 Primary Care physicians last month in FL and one of the take home points I tried to leave them with was that “The single most common x-ray taken in my office is the weight bearing view of the knees.” We also talked about the fact that the patient needs to go into this type of procedure with open eyes and realistic expectations. Following arthroscopy, many surgeons give their patients the intra-operative photographs of the knee so they can have a visual reference to understand what they’re dealing with and what the future holds for them.

So, if you are considering a scope to “clean out the knee/knees at the end of the season to get ready for 2013,” make sure you’ve had the correct x-rays and have gone through the options carefully with your surgeon. Good luck.