Hey Everyone,
In this article Thorlund continues the discussion of mechanical knee symptoms as it relates to the meniscus. If you’ve been following the research on the topic, we have mounting evidence contradicting long held beliefs/narratives regarding the meniscus and need for surgery as it relates to degenerative tears and OA. Give this one a read and let us know what you think.
Good read. Anecdotally, I’ve seen a lower prevalance of arthroscopic surgery for the management of degenerative tears and OA where I currently work in LA, but it was certainly not the case at my previous location. The financial incentive for this surgery seems to be one of the major barriers with respect to dissemination of this information and its application, but I suppose that’s the case with most things. From a physical therapy standpoint, de-education and effective rehabilitation can be difficult because many people have already ascribed weightbearing activities (ie things that are helpful when dosed appropriately) to degeneration and dysfunction. Thanks for the read, Mike.
Thanks for the response Mark. I agree, depending on who was initial contact on the case and narratives provided, this can be a difficult process of reversal. Once the mechanical narrative has been provided, then naturally many people think the mechanical issue needs correcting, despite what evidence is demonstrating. Hopefully, we can all keep disseminating the evidence to the front line and shifting the paradigm.
Is there anything to make of the significant difference in number of participants in each group ie. 641 with a tear and 176 without a tear at surgery, or is it more important to pay attention to the prevalence of tear/no tear in regards to the mechanical symptoms? What can we take away from the large difference in number, if anything?
Thanks!
It means that surgeons do better than a coin flip when deciding who to take for surgery with suspicion for a tear (which is what we’d hope, of course … if they were “equal”, it would suggest that surgeons just take people for surgery indiscriminately). That decision does not come solely from a patients reported “mechanical” symptoms, but from the totality of evidence they obtain during their subjective and objective evaluation. These data suggest that that particular subjective symptom report is not as useful as we’d like it to be in differentially diagnosing these patients.
Understood! Makes a lot more sense now. Ill give those other articles a reach Michael and thanks Austin for the explanation!