​A group of experts advised strongly against using arthroscopic surgery for nearly all patients with degenerative knee disease, in a rapid recommendation published May 1, 2017, in The BMJ. Arthroscopic knee surgery is performed globally more than two million times each year and costs more than $3 billion annually in the United States alone. The authors analyzed data on 1,668 patients from 13 randomized trials and 12 observational studies and found that fewer than 15% of patients felt an improvement in pain and function three months after the procedure. Even when pain and function improved, the positive effects largely disappeared after one year, the authors said. About 25% of people older than 50 experience pain from degenerative knee disease, the authors said. Many patients try less invasive strategies before opting for surgery. The authors strongly recommended conservative management strategies such as exercise therapy, injections, or pain medication as an alternative to surgery. Further research was unlikely to alter the recommendation, the authors said, and the recommendation applied to patients even in cases in which arthritis is not visible through imaging.

HRC Recommends: Recommending a course of treatment, managing patient expectations, and obtaining informed consent require careful judgment and communication with patients and families. Orthopedic surgeons should ensure that the informed consent process includes a discussion of what the patient can and cannot expect from arthroscopic surgery for degenerative knee disease. The standardized informed consent document should be made educational and personalized to address the individual patient and should provide information in five key areas: risks, benefits, alternatives, experience, and cost to the patient.