"The prospect of resolving nagging knee pain  or discomfort thats come on fairly sudden  drives many patients to go under the knife httpshealth.usnews.comhealthnewspatientadviceslideshowswaystoprepareforsurgery specifically to have an arthroscopic knee procedure done.  During the procedure an orthopedic surgeon inserts a tiny camera  or arthroscope  through a small incision to view the inside of the knee. The doctor then attempts to surgically address the knee pain httpshealth.usnews.comhealthnewspatientadvicearticlesrecoveringfromchronickneehipandbackpainwithoutsurgery such as making repairs to a torn meniscus  a Cshaped disc that cushions the knee  or realigning a misaligned patella or kneecap.  There are some limited circumstances where its helpful says Dr. Reed Siemieniuk an internist in Toronto and a doctorate student in health research methodology at McMaster University in Hamilton Ontario. That includes young patients who have sports injuries or tears in the ligaments of the knee he says and patients who have bleeding in the knee  to try to figure out where the bleeding is coming from and address that. The surgery could also benefit individuals of any age whove suffered a traumatic injury to the knee such as a meniscus tear. An example of a good candidate for arthroscopic knee surgery would be a yearold who twists his knee getting up from a seated position or while playing tennis says Dr. Joseph Bosco httpnyulangone.orgdoctorsjosephbosco a professor and vice chair of the department of orthopedic surgery at NYU Langone Medical Center httpshealth.usnews.combesthospitalsareanynyulangonemedicalcenter. See  Exercises You Can Do Now to Save Your Knees Later httpshealth.usnews.comwellnessslideshowsexercisesyoucandonowtosaveyourkneeslater. But a metaanalysis http led by Siemieniuk of research on arthroscopic knee surgery strongly recommended against knee scoping in nearly all patients with degenerative knee disease. The clinical practice guideline was published in the BMJ in May. The analysis evaluated arthroscopic knee surgery for degenerative knee disease which is often synonymous with knee arthritis. It is knee pain or locking that occurs with use or overuse. The most common risk factor is being overweight or obese Siemieniuk explains. We use the term degenerative knee disease rather than arthritis because some surgeons restrict the diagnosis of arthritis httpshealth.usnews.comhealthnewspatientadvicearticleslivingwithosteoarthritis to those diagnosed by Xray or MRI when in reality many people have degenerative knee disease with normal Xrays and MRIs. Meniscus tears are also a common finding in those with arthritis or degenerative knee disease and are not associated with knee symptoms but are often used as a reason to operate he adds. In all of those groups of patients arthroscopic surgery  doesnt have any longterm benefit for pain or for function or quality of life Siemieniuk says. But it does have some downsides including two to six weeks recovery time and some rare but more serious adverse effects like blood clots that can sometimes be fatal and infection. The procedure is generally considered safe but given the lack of evidence demonstrating a longterm benefit in these common scenarios clinicians and patients should look at other nonsurgical options to address knee pain the researchers assert. The alternatives they cite include losing weight httpshealth.usnews.combestdietbestweightlossdiets if a person is overweight physical therapy corticoid steroid injections and other types of injections into the joint to treat pain or taking nonsteroidal antiinflammatory drugs known as NSAIDs. httpshealth.usnews.comhealthnewshealthwellnessarticleslongtermbabyaspirinothernsaidusemaylowercoloncancerrisk Then if its severe and it really is interfering with your quality of life and its persistent  some people require knee replacement surgery Siemieniuk says. But nowhere along that line should ... arthroscopic surgery which is even more common be performed. Bosco says he generally agrees with the recommendation set forth and that it doesnt change the way he practices. But he emphasizes that each patient has to be treated individually. The recommendation suggests similarly that individual factors and patient values and preferences must be taken into account. The expert panel that created the guidelines published in the BMJ included not only doctors but also several patients who had osteoarthritis including one whod had arthroscopic knee surgery.  Our strong recommendation against arthroscopy reflects a low value on a modest probability less than  percent of small or very small improvement in shortterm pain and function that does not persist to one year and a higher value on avoiding the burden postoperative limitations and rare serious adverse effects associated with knee arthroscopy the researchers wrote. The panel felt that almost all patients would share these values. The recommendation is not applicable to patients who do not share these values that is those who place a high value on a small uncertain and transient reduction in pain and function and a low value on avoiding the burden and postoperative limitation associated with arthroscopy the researchers added. See Osteoarthritis and Activity Walking It Out httpshealth.usnews.comhealthnewspatientadviceslideshowsosteoarthritisandactivitywalkingitout. But many arthroscopic surgeries are being done that dont benefit patients Siemieniuk stressed. In Ontario approximately  percent of arthroscopic surgeries are performed for degenerative knee disease he says. Though he adds that its difficult to know exactly what proportion of arthroscopic knee surgeries were for degenerative knee disease in the United States the researchers reported that arthroscopic procedures for degenerative knee disease cost more than  billion per year in the U.S. alone according to previous research. Citing other studies they report that arthroscopic knee surgery for degenerative knee disease is the most common orthopedic procedure in countries where data is available and that more than  million procedures are done annually worldwide. Despite the concern that many arthroscopic surgeries are being performed on patients who wont benefit some clinicians say these type of guidelines have already been adopted by many surgeons. The new recommendation comes as no surprise says Dr. Alejandro Gonzalez Della Valle https_gonzalezdellavallealejandro.asp a hip and knee surgeon at Hospital for Special Surgery httpshealth.usnews.combesthospitalsareanyhospitalforspecialsurgery in New York City. For a number of years we have known that if we offer arthroscopic surgery to patients who have moderate or severe arthritis they generally dont do well in the longterm he says. Frequently patients with lots of arthritis in the knee also have torn meniscus. But performing arthroscopic surgery wont relieve a patient of the discomfort from the underlying arthritis. Fixing the torn meniscus will not cure the patients pain he says. Under those conditions the surgery will not be useful or effective or will not provide any benefit to the patient. See  Things to Know Before Your Hip Replacement httpshealth.usnews.comhealthnewspatientadviceslideshowsthingstoknowbeforeyourhipreplacement. On the other hand some patients have very minimal arthritis in the knee and a very severe meniscal tear producing a lot of pain. In our clinical impression those patients can do well for several years with arthroscopic surgery he says. So its all about patient selection at the end of the day. For ideal arthroscopic candidates  like those who suffer a traumatic or sportsrelated meniscal tear who have no arthritis  arthroscopic surgery can provide a permanent fix. Experts suggest the first step for anyone with persistent knee pain is to talk with an orthopedic specialist about all treatment options. Typically nonsurgical options are recommended to start though circumstances vary by the patient and so a thorough exam including MRI httpshealth.usnews.comhealthnewspatientadvicearticleswhenyourkidneedsanmrioptimizingtheexperience imaging of the knee is pivotal to inform the best course of action. For those with arthritis in the knee there is unfortunately no quick fix and experts say while different approaches can reduce pain its also important to have realistic expectations  rather than simply having surgery thats not proven to provide longterm benefit. I think its a matter of understanding what the limitations of modern medicine are Siemieniuk says. 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Schroeder https Staff Writer Michael O. Schroeder has been a health editor at U.S. News since . He writes health stories...  Read more Tags health https patients https patient advice https arthritis https sports https sports medicine https_medicine surgery https bone joint health https_joint_health"