PainSci summary of Kirkley 2008?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
In 2002, Moseley published the results of a fascinating experiment that showed that people who received a fake arthroscopic knee surgery had results just as good as people who received the real surgery for osteoarthritis. Six years later, these findings were fully supported by a Cochrane Collaboration review (Laupattarakasem et al), which concluded that “there is ‘gold’ level evidence that arthoscopic debridement has no benefit.” As if that wasn’t enough, this study piled on and reported the same thing again: “no additional benefit to optimized physical and medical therapy.”
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown.
METHODS: We conducted a single-center, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic debridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life).
RESULTS: Of the 92 patients assigned to surgery, 6 did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After 2 years, the mean ([+/-]SD) WOMAC score for the surgery group was 874[+/-]624, as compared with 897[+/-]583 for the control group (absolute difference [surgery-group score minus control-group score], -23[+/-]605; 95% confidence interval [CI], -208 to 161; P=0.22 after adjustment for baseline score and grade of severity). The SF-36 Physical Component Summary scores were 37.0[+/-]11.4 and 37.2[+/-]10.6, respectively (absolute difference, -0.2[+/-]11.1; 95% CI, -3.6 to 3.2; P=0.93). Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery.
CONCLUSIONS: Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.
- “A controlled trial of arthroscopic surgery for osteoarthritis of the knee,” JB Moseley, K O’Malley, NJ Petersen, and others, New England Journal of Medicine, 2002.
- “Arthroscopic debridement for knee osteoarthritis,” W Laupattarakasem, M Laopaiboon, P Laupattarakasem, and C Sumananont, Cochrane Database of Systematic Reviews, 2008.
These two articles on PainScience.com cite Kirkley 2008 as a source:
- PS Save Yourself from Patellofemoral Pain Syndrome! — Patellofemoral pain syndrome (aka runner’s knee) explained and discussed in great detail, including every imaginable self-treatment option and all the available scientific evidence
- PS Knee Surgery Sure is Useless! — Evidence that arthroscopic knee surgery for osteoarthritis is about as useful as a Nerf hammer
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.