As middle age and baby boomer patients continue their athletic pursuits there is an increased number of sports related injuries that affect the knee. There has been an explosion in the use of MRI scan for diagnosing knee problems and many patients in their 40s, 50s, and 60s will have small meniscal tears that may or may not be significant. That begs the question what is the role of arthroscopy in the treatment of the early arthritic knee. Certainly if patients have some arthritis, but significant mechanical symptoms, i.e. catching, locking that would signify a significant meniscal tear and or loose body then arthroscopic evaluation may be appropriate. If the MRI scan demonstrates erosion of the cartilage and edema or “swelling” in the underlying bone then the risk that arthroscopy will not benefit your symptoms is significant. I see a large number of patients who have had arthroscopy on an arthritic knee and subsequently have no improvement in their symptoms and present for more surgery within the year after the arthroscopy. If you have an MRI scan that shows a small meniscal tear, but no mechanical symptoms and there is moderate arthritis in your knee it would be preferential to treat that with nonoperative methods such as anti-inflammatory medications and injections of either cortisone or viscosupplementation first before you consider arthroscopic treatment. Often these symptomatic treatment modalities will solve the problem or improve your symptoms and you can avoid arthroscopic treatment, which may be of no benefit if you have arthritis in your knee. The presence of a meniscal tear alone on MRI scan in a patient with arthritis does not indicate a need for surgery. It is important for middle age and older patients to weigh the options before jumping into arthroscopic treatment of an arthritic knee which may not provide significant benefits.
— William P. Barrett, MD
