Hi.
This is Dr. Centeno and today we're going to talk about
when is knee surgery necessary?
It's a huge question that a lot of patients have.
There are three common things on the MRI
of a patient with knee pain that drive most
of the arthroscopic surgeries.
These are bone spurs, a hole in the cartilage,
or meniscus tears.
Now, basically, what happens is a patient comes in with knee
pain to see the doctor.
He doesn't know what's going on.
An MRI is taken.
It shows one of those three things.
And we end up with the surgery.
What if these things weren't causing the pain.
Would surgeries still be needed?
Absolutely not.
So let's look at the largest study
or one of the largest studies to date
called the Framingham Osteoarthritis study.
It looked at 710 people, out of which 206 of them
had knee pain, and then they looked at MRIs
to try to see the difference between people that
had pain and didn't have pain.
So, do bones spurs cause knee pain?
They get operated on all the time
and you would think that they're being taken out because they're
causing pain to try to help the pain,
but if we look at the Framingham data
and the percentage of people with bone spurs on their MRI,
they're pretty much the same.
In fact, these are statistically identical.
So that means that bone spurs aren't causing pain,
because we have an awful lot of people
out there who have bone spurs but have no pain.
So taking these bone spurs off surgically
makes no common sense.
Well, surely, cartilage damage or a hole in the cartilage
has to cause pain.
In fact, there are hundreds of thousands
of surgeries in the US alone done
to try to fix these holes in cartilage.
That's got to be causing pain.
Well, let's look at the Framingham study.
This is the percentage of people who
had holes in the cartilage on their MRI,
and as you can see here, they're almost identical.
And again, these are not statistically different.
So a whopping 43% of patients without any pain
had holes in their cartilage.
So again, doesn't make sense to operate
on people who have holes in their cartilage
if those holes aren't causing them pain.
And do meniscus tears cause knee pain?
I mean, after all, this is probably
the most common surgery in the United States today.
Meniscectomy.
Going in and trying to repair, which
happens very infrequently, or more likely,
cut out the torn piece.
So again, let's look at the data.
If we look at knee pain and no pain,
again, they're virtually identical.
We had as many people with no pain
as who have knee pain who have meniscus tears.
And there really isn't anything that's
different about these two numbers.
So, at the end of the day, meniscus tears
don't cause pain, hence operating
on meniscus tears, not such a good idea.
So this and other studies show that we
shouldn't be operating on knees with these issues to help pain.
But in fact that's what happens all the time.
And in fact, right now, more than a million surgeries a year
are performed on these phantom issues.
And I call them phantom issues because they're not
causing pain, clearly, and yet we're
operating on these as if they are causing pain.
So if you want to learn more about how to fix these things
or help these things, or what's really causing your knee
pain outside these phantom things picked up on the MRI,
then take a few minutes and read my book Orthopedics 2.0.
I think it'll answer a lot of questions.
Thanks so much for watching.