Routine knee arthroscopic surgery for the painful knee in middle-aged and old patients—time to abandon ship

Knee arthroscopic surgery is one of the most common orthope- dic procedures. Introduced in Scandinavia in the late 1970s, it replaced and improved earlier open knee procedures, changed most of them from inpatient surgery to outpatient surgery, and drastically cut patient recovery time. Earlier case reports of open surgery had suggested that in the presence of “degenera- tive” changes in the joint at the time of meniscectomy, patients improved—but less so than in the absence of such changes (Jackson 1968, Appel 1970). Subsequent reports, now using arthroscopic surgery, again suggested poorer results in patients with cartilage changes (Lysholm and Gillquist 1981, Northmore-Ball and Dandy 1982, Gillquist and Oretorp 1982, Hamberg and Gillquist 1984).