Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Cochrane Musculoskeletal has produced more than 200 systematic reviews of interventions for the prevention, treatment or rehabilitation of musculoskeletal disorders. These were added to in March 2022 with a new review of the effects of a type of surgery called knee arthroscopy. In this podcast, Ray Moynihan from Bond University in Australia, talks with lead author, Denise O'Connor, from Monash University and Cabrini Hospital in Melbourne.

Ray: Hello Denise, first of all, could you tell us a little about this type of knee surgery. What is it and what does it do?

Denise: Hello Ray. Knee arthroscopy, which is keyhole surgery to the knee, involves making small cuts in the skin over the knee to insert a camera and surgical tools that are then used to remove tissue from the knee joint. Most knee arthroscopies are done in older people with degenerative conditions such as knee osteoarthritis.

Ray: Thanks. How common is it and why is it important to have reliable evidence on its effects?

Denise: It's actually very common and is needed when the cushion (or cartilage) between the knee bones breaks down because of wear and tear. Sometimes the menisci, the rubbery discs between the bone ends, are also affected. People with knee osteoarthritis may experience pain, stiffness and swelling in the knee which may limit their day-to-day activities.
Some of the ways to help manage this include maintaining a healthy weight, exercising to improve knee strength and overall fitness, and using pain-relieving medicines when needed; but some people may decide to consider going on to other treatments, such as arthroscopic surgery. This means that it's important to have scientific evidence on the effects of arthroscopic surgery for people with degenerative knee disease to help people in making an informed decision.

Ray: Were you able to find the evidence you needed?

Denise: Yes, we identified 16 clinical trials involving just over 2100 people that compared arthroscopic surgery to either placebo (or fake) surgery or to non-surgical interventions, such as exercise, injections, medications, or supplements and complementary therapies.

Ray: And what does this evidence tell us about arthroscopic surgery for treating knee osteoarthritis?

Denise: Based on these trials, we're confident that arthroscopic surgery does not provide any clinically important benefits in pain or function for people with knee osteoarthritis. It also probably doesn't provide any clinically important benefit for quality of life and may not improve patient-reported success compared with a placebo operation.

Ray: What about the safety aspect? Did you find any evidence about complications and adverse events among people having the surgery?

Denise: Not all of the trials reported on complications, and we're less certain of the risk of these than we are about the evidence on the clinical benefits. However, we did find that arthroscopic surgery may lead to little or no difference, or a slight increase, in serious and total adverse events (such as infections, blood clots, heart attack) compared to placebo surgery or non-surgical treatments. 

Ray: Overall, then, what's your take-home message about the effects of arthroscopic surgery for knee osteoarthritis?

Denise: At its simplest, our review shows that arthroscopic surgery for degenerative conditions like knee osteoarthritis provides no important benefits in pain or function and may expose people to increased risk of harm. 

Ray: Thanks Denise. Finally, if people would like to read the review, how can they get hold of it?

Denise: Thanks Ray. The full review's online at www Cochrane Library dot com and can be found by typing 'arthroscopic surgery' into the search box.