Nearly all undergo MRIs, which may show damage to ligaments and other structures in the knee (ACL tears, torn menisci, etc.). You get the idea: These findings, too, are nonspecific -- likely to be found in the knees of many who are walking or jogging today.
In our culture, the top of the therapeutic pyramid is occupied by the most technically based, usually invasive, potentially dangerous, expensive treatments. Some patients head straight for the top; others limp up only when their knee pain persists despite alternatives. Near the top are the doctors who are willing to inject something into your painful knee. They carry the most marginal scientific support of effectiveness. At the summit, decorated and highly rewarded, are the surgeons who are trained to fix the knee.
Science or no science, it is difficult for a surgeon and more difficult for a patient to see a damaged structure in the knee without linking the knee pain to that structure and fearing for the future. Furthermore, if the damage is reparable, shouldn't it be fixed?
Such reasoning induced a generation of orthopedic surgeons to offer their services in removing torn menisci by cutting open the knee. It took quite a while for patients to recover from the procedure, but most did. Most also have damaged knees when followed up decades later. Was the damage a result of whatever led to the tearing of the menisci in the first place or the surgery? We don't know. We do know that removing torn menisci by opening the knee is no solution in the long run.
Then along came arthroscopic surgery. Surgeons can now remove torn menisci, smooth damaged cartilage and repair other ligaments through tubes inserted into the knee using three tiny incisions. Recovery is rapid. The technology is impressive, though less impressive than modern digital cameras. The dexterity required also is impressive, though less so than the skill required to play most modern video games.
More than 500,000 knees are subjected to invasion by arthroscopes each year. It is the commonest elective orthopedic procedure in America. Most patients are grateful and bear the stigmata, the three little scars, as a sign of triumph. Arthroscopy is certainly responsible for a great transfer of wealth as this is an expensive procedure, but any certainty as to the specific benefit is being called into question by two recent randomized controlled studies of the procedure.
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