The BKS Position Statement on The Role of Knee Arthroscopy, October 2018

There has recently been significant comment in both the general press as well as in some general medical journals regarding the role of knee arthroscopy in degenerate knees. This has culminated in some very poorly informed and misleading comments, such as ‘knee arthroscopy doesn’t work!’. Some non-specialists have even published their own guidelines, recommending that the use of knee arthroscopy should be restricted and that surgery should be withheld from and denied to some patients. This includes articles and comments from publications such as The British Medical Journal and The British Journal of Sports Medicine (i.e. journals that are not actually specialist surgical journals).

Knee arthroscopy is a term that simply describes a method for looking into a knee joint with a camera. It says nothing about why surgery might be needed, what might actually be found inside the joint or what the surgeon might actually do inside the knee. Knee arthroscopy does work, when it is done at the right time, for the right reasons, in the right patient, with the right techniques and procedures by a good surgeon with the right training and the correct experience.

It is important that guidelines are seen for what they are, and only used in an appropriate fashion: they should be considered purely as just aids to assist professionals and patients in their clinical decision-making. They should not be used as blunt weapons to ration patients’ access to appropriate healthcare. Guidelines are particularly dangerous when written by individuals who are not actually specialists in the field on which they are commenting.

Appropriately selected patients with degenerative changes in their knee can benefit significantly from knee arthroscopic surgery. The decision as to whether any individual patient might benefit from arthroscopic knee surgery is a decision that should be taken purely between the patient themselves and an appropriately qualified experienced specialist knee surgeon.

Background

The phrase ‘knee arthroscopy’ simply means ‘looking into a knee joint with a camera’. It is nothing more than a method whereby surgeons can look inside a knee. The term ‘knee arthroscopy’ tells you nothing about why a patient might actually need the surgery, what might actually be found inside the joint or what might actually need to be done inside the knee. There is a very long list of different ‘arthroscopic procedures’ covering a wide array of surgical techniques available for ‘tidying up’, repairing or reconstructing the various structures within a knee joint. To lump all of these together under the single term ‘knee arthroscopy’ is enormously over-simplistic at best, and perhaps even quite disingenuous at worst!

Knee arthroscopy was first introduced into the UK back in the 1970s as a tool for improving the treatment of patients’ knees with more delicate, less invasive tissue-preserving techniques. Many of the comments that have recently been made have come from people who are not experts in the field, and who are not actually knee specialists. It is our opinion that many of these comments are ill-informed, naïve, over-simplistic, inappropriate and, indeed, actually quite damaging for patient care. As surgeons, we strongly deplore the practice of any patient ever undergoing any kind of surgery that they might not need, and we would most certainly strongly condemn any such malpractice. However, we believe that the decision as to whether any particular individual patient might potentially benefit from surgery, and the details of exactly what surgery might be required, is something that can and should only ever be made after a full and detailed assessment, and after a proper face-to-face discussion between the patient themselves and a fully qualified appropriately experienced specialist knee surgeon.

To deny patients access to appropriate surgical solutions and to unduly ration patients’ access to appropriate healthcare through scaremongering by non-experts is something that should be deplored.

Footnote:

The Biological Knee society was set up to promote very latest and best possible surgical options and techniques for knee reconstruction. It is dedicated to the study, evaluation and promotion of the very best surgical options for patients with damaged knees who are too young for artificial joint replacement surgery.

Published 27-10-18