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Author Topic: studies showing arthroscopy doesn't help or brings on arthritis?  (Read 401 times)

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Offline reader278

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Hi all,

I have suffered with debilitating knee pain for 2 years. Have severe patellofemoral syndrome with no obvious damage on MRI but evidence of synovitis (no rheum conditions found). I can't even participate in physio because the pain just gets worse even with really gentle physio. Both synvisc and PRP did nothing or potentially made it worse. So at this point I have opted for arthroscopy with Dr. Dye (not for a lateral release or anything, just partial synovectomy and maybe clearing out any cartilage fragments if he sees any). But then I'm reading these studies saying arthroscopy doesn't help with stuff other than acute sports injuries. Also there are so many horror stories on this site! What do you guys think, has arthroscopy helped you?

Offline Brandon123

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Re: studies showing arthroscopy doesn't help or brings on arthritis?
« Reply #1 on: January 19, 2018, 09:28:25 AM »
So you haven't seen any positive results from the PRP yet?

Yup, you're right, many studies are showing that arthroscopy is no better than sham surgery even when you have obvious cartilage damage, like chondromalacia or arthritis. Especially long-term. I had a arthroscopy 2009 (at the time I was almost as bad as you), it took me quite a while to recover, but I eventually became almost normal again. However, the knee broke down again completely 2015 and the initial (minor) cartilage damage had then progressed to arthritis. So, all in all, I think the arthroscopy (probably the clean up and cartilage debridement reduced inflammation/irritation) bought me a few years, but now I am back where I started and even a bit worse.

Note, I do believe Dr. Dye's approach to arthroscopy is a little bit different than what they performed in most of those studies. His main reason for the procedure, if I have understood correctly, is synovectomy to reduce the chronic inflammation, not cartilage clean up and debridement.

But also remember that your case is a bit different than mine and others on the forum, because you have no obvious cartilage damage, and hence, the case for surgery is even weaker. Have you read about this guy? He was as bad as you (despite no cartilage damage) and also a patient of Dr. Dye and eventually recovered without surgery:

http://themindfulcaveman.com/my-knee-story-part-1-injury-and-recovery/ 

To sum up, maybe a clean up (if you have some cartilage fragments or something) and synovectomy will help, nobody can tell. If you do it, I still think it is good that you go with Dr. Dye as he will probably not perform any surgery unless he thinks it is absolutely necessary. But still, this should be your last option.
« Last Edit: January 19, 2018, 09:39:38 AM by Brandon123 »
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reader278

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Re: studies showing arthroscopy doesn't help or brings on arthritis?
« Reply #2 on: January 19, 2018, 06:25:48 PM »
I have not seen any results from the PRP in fact my pain is worse now, seems to have stirred up the synovitis just like the synvisc!! and caused me to lean more on my right leg which got worse.  I talked with Dr. Dye about the studies..and I'm not sure what to think. He seems to think synoctomy and potentially clearing up any loose cartiledge fragments will be helpful and will expand my envelope of function so I'm going to go through with it...because I've been trying conservative measures for the past 2 years which is a fair trial I would say. The surgeries done in those studies were focused on OA which is not my diagnosis at this current time, so not sure how to interpret that.

Brandon, The exact same thing happened to me when I tried to expand my envelope of function like you too soon and everything deterioated. I'm never going to try to run again, that's for sure!  And if I get back to normal walking my plan is to limit my exercise to pilates and the pool. I'm also really concerned about pregnancy, but willing to use a wheelchair if need be for that.

Offline Brandon123

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Re: studies showing arthroscopy doesn't help or brings on arthritis?
« Reply #3 on: January 20, 2018, 09:21:06 AM »
Yes, having tried conservative treatment for over 2 years myself, I understand your frustration. Sorry to hear about the PRP. Viscosupplementation did nothing for me either, except stirring up inflammation.

An important lesson from all of this is: if you have had serious knee problems, and gotten much better, be careful! Better to be safe than sorry. After a few years (after injury and surgery) I felt almost completely normal in my knee (no pain, unlimited walking and stair climbing etc.), and took up running again in 2015, and within a few days after my first run, it all went downhill again.

Please keep us updated on how the situation develops!

RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment