The most common knee surgery performed on people over 65 is repair of torn meniscus cartilage. The procedure is costly, at up to $10,000 a patient — and it’s also usually a waste, if not outright harmful.
“It’s known that this procedure is often done without strong evidence; I don’t think it’s well known that this is one of the most common surgeries in the U.S.,” said Martin Makary, a professor of health policy at Johns Hopkins Medicine in Baltimore and author of a recent study in the Journal of the American Medical Association Surgery. “We not only described it, we looked at it in a population every American pays for (through Medicare). That’s a price tag and a context I’m not sure people have really calculated.”
That giant waste of money could be better spent on other treatments, from something as simple as Advil to more sophisticated courses of physical therapy that will give most patients better results, researchers at Johns Hopkins Medicine say.
The problem is that there are two kinds of meniscus tears, said David Altchek, an attending orthopedic surgeon at New York’s Hospital for Special Surgery and the medical director for the New York Mets. Only one of the two tears, the much less common one, responds to surgery, Altchek said.
Arthroscopic procedures for acute injuries are fine and are often done in conjunction with physical therapy to rebuild strength in the joint. These are mostly done on younger patients, who get hurt doing everything from playing basketball to misstepping off a commuter train. The issue with seniors is that their meniscal injuries are more often the result of wear and tear, and they often or even usually coincide with osteoarthritis, Altchek said.
Indeed, the cartilage that wears out in seniors is a different kind of tissue than what is damaged in acute injuries — the cartilage that bothers older patients is usually articular cartilage, while younger patients injure meniscal cartilage.
Articular cartilage is usually found on the surface of bones in the knee joint, and when it wears out, it produces a duller ache. Meniscal cartilage is more like a pad between joints and can produce a sharper pain, especially when it’s injured all at once rather than over time.