The removal of the menisci, located in the knees, is an operation too often performed according to some surgeons. They warn of the risks associated with this intervention. Among them, premature wear of the knees.
“Save the menisci!”. Here is the cry launched by a group of surgeons belonging to the Francophone Society of Arthroscopy (SFA), gathered in congress since Wednesday, December 11 in Rennes. They wish to warn about the removal of the meniscus, an operation that is too frequent and yet involves long-term risks. Indeed, having knee pain is no longer exclusively reserved for people of a certain age. And for these surgeons, having a knee like “rusty” in the prime of life is often linked to an operation performed on the menisci five, ten or twenty years ago.
Intervention on these two small crescent-shaped cartilages, which play a stabilizing and shock-absorbing role in the joint, may be necessary. Because a damaged meniscus can result in significant pain, swelling of the knee or an obstacle to the mobility of the joint. But for these surgeons, this operation is performed too much and too radically. However, it is possible to keep part of the cartilage, repair it, or even not operate at all, according to members of the SFA.
An overly trivialized operation…
Surgeons believe that the removal of the menisci is “trivialized”, “sometimes abusive”. Especially since the general public and the health authorities do not seem to worry about the subject. “We want to train and inform surgeons, but also raise awareness among all stakeholders for public health purposes: patients, decision-makers, sports doctors, etc.,” says Yacine Carlier, board member of the Société francophone d’arthroscopie. Yet in 2008, the High Authority for Health (HAS) recommended to privilege the conservation of the meniscus when it is possible and to carry out an ablation “as partial as possible” when an intervention is necessary. For the members of the SFA, this is still far from being the case in France, but also in many countries.
…For practical and economic reasons
According to surgeons, of the 200,000 to 250,000 patients operated in France each year either on the meniscus alone or at the same time as the cruciate ligaments, only 5% undergo meniscal repair. However, “at least 15% of the lesions could be repaired”, estimates Nicolas Pujol, secretary general of the SFA. Thus, tens of thousands of additional patients could retain their meniscus each year. But why do doctors perform meniscal removal so much? Because the operation is easier and cheaper. In addition, “the immediate consequences are positive”, with less risk of operating again, faster recovery. So patients are also opting for this option more often.
Osteoarthritis, long-term chronic pain
In the long term, the absence of menisci increases friction in the knee and premature wear of the joint. There are also risks of chronic pain and a sharp increase in the likelihood of osteoarthritis. According to an American study published in 2016, repairing the meniscus represents $2,400 in less medical expenses after 30 years compared to partial removal. Life expectancy in good health would also be lengthened. The surgeons of the SFA hope, in the future, a financial revalorization of the meniscal repair. This would encourage hospitals and clinics to practice it more.
.