Is Knee Surgery Really the Best Way to Fix Pain?

For many people, knee pain is a common part of getting older. When an MRI scan shows a tear in the meniscus—the rubbery cartilage that acts as a cushion in the knee—it is natural to want a quick fix. Many patients choose to have arthroscopic surgery, a common procedure where a surgeon uses small tools to trim away the damaged tissue. However, new research suggests that this operation might not be the best answer for everyone.

According to KFF Health News, a recent study has raised serious questions about the effectiveness of this surgery. Researchers followed patients for 10 years to compare those who had the actual surgery against those who only received a “sham surgery,” which is a small skin cut that looks like an operation but does not fix the inside of the knee. The results were surprising: the surgery provided little or no real benefit. In fact, the study found that patients who had the surgery were more likely to develop osteoarthritis—a condition where the protective cartilage at the ends of bones wears down over time—and often needed more operations, such as a total knee replacement, later on.

Teppo Järvinen, an orthopedist and the head of the Finnish Centre for Evidence-Based Orthopaedics, was one of the authors of this study. He noted that the findings were very clear. He stated that patients who had the procedure often ended up with more pain and worse overall results. Järvinen explained that for many people over the age of 50, these cartilage tears are simply a normal result of wear and tear, and they are often not the true cause of the patient’s pain. Because of this, he argued that there is very little evidence to support performing the surgery for these types of conditions.

This study does not apply to everyone. It specifically focuses on middle-aged or older adults with general knee pain. It does not include people who have suffered a sudden, serious injury to their knee. For those with acute injuries, surgery might still be necessary. However, for the millions of people who have pain caused by aging, the medical community is changing its view. Evidence has been growing for over a decade that physical therapy—exercises designed to strengthen the muscles around the knee—can be just as effective as surgery without the risks of an operation.

Despite this, the use of surgery remains common. KFF Health News reports that while the number of these procedures has dropped in some places, such as Finland, the decline in the United States has been much slower. Data shows that between 2010 and 2020, there were over 2 million meniscus surgeries in the U.S. While the number of these operations in the traditional Medicare program—the U.S. government health insurance for older people—has fallen from about 169,000 in 2014 to 91,000 in 2024, the surgery is still performed frequently.

There is also a lack of agreement among doctors. Robert Brophy, the director of the Orthopaedic Clinical Research Center at Washington University in St. Louis, noted that while the evidence for being careful with surgery is growing, many patients still feel they benefit from it. He admitted that current medical practices are inconsistent. For instance, data shows that surgery for meniscus tears is much more common in the southern United States than in the Northeast. This suggests that a patient’s chance of getting surgery might depend more on where they live than on their specific medical needs.

Last June, a large group of orthopedic societies from Europe and the U.S. released a statement on this issue. They agreed that patients with these types of cartilage tears can often be treated with either surgery or non-surgical methods, such as physical therapy, with similar results. They recommended that patients try physical therapy first before deciding to have an operation. Even so, the group did not completely stop supporting the surgery.

For patients, the message is clear: it is important to talk to a doctor about all options before choosing an operation. Since physical therapy can often provide the same relief without the risks of surgery, many experts now believe it should be the first step. As more research becomes available, it is likely that doctors will continue to move away from surgery and toward treatments that help patients manage their pain in safer, more natural ways.