Intended for healthcare professionals


Knee arthroscopy: influence of systems for delivering healthcare on procedure rates

BMJ 2015; 351 doi: (Published 24 September 2015) Cite this as: BMJ 2015;351:h4720
  1. David F Hamilton, research fellow,
  2. Colin R Howie, professor of orthopaedic surgery
  1. 1Orthopaedics, University of Edinburgh, Edinburgh EH16 4SB, UK
  1. Correspondence to: C R Howie colin.howie{at}

The “correct” rates of discretional interventions are difficult to define. However, David Hamilton and Colin Howie point out that discrepancies in usage of knee arthroscopy within the UK suggest the organisation of the care pathway may be an important determinant

Osteoarthritis of the knee can result in joint pain and reduced physical function. Treatment includes analgesia, physical therapy, and surgery.1 Although arthroscopic surgery has been widely used in the management of knee osteoarthritis for over 20 years, evidence of efficacy is lacking.2 3 4 5 6 Studies have shown no additional benefit compared with sham surgery or conservative treatments.2 In the current resource strapped healthcare climate treatment should be both efficacious and targeted at the most appropriate patients. We examine patterns of use of arthroscopy in England and Scotland and look at possible explanations for differences between the two countries.

Evidence on effectiveness

The most recent Cochrane reviews highlight no benefit in terms of pain relief or physical function from arthroscopic washout or debridement for patients with osteoarthritis of the knee.3 4 Two meta-analyses also suggest no benefit,5 6 with the most recent noting that arthroscopy is not without hazard and that this should be considered in the light of poor efficacy.6 Arthroscopic menisectomy does, however, have a role in specific patients. A recent randomised study in patients with no signs of osteoarthritis on plain radiography but who had persisting medial joint line knee pain despite conservative management found that meniscal resection was beneficial.7 Current guidance from the National Institute for Health and Care Excellence (NICE) suggests that referral for arthroscopic lavage and debridement should not be offered unless the person has a clear history of mechanical locking.1 But in a poll on after the most recent meta-analysis was published, 70% of respondents thought …

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