Quote Originally Posted by JFord View Post
Hi Will.

I think it's important to read the study you're citing very carefully. There were a LOT of exclusion criteria. One of them was pain that can be directly explained by the actual results of the imaging. That means that the study you're referring to would not have included such patients within the study group.

Patients like me. I had meniscal debridement done arthroscopically and my excruciating pain for almost a year improved by about 80% from the time I woke up from my surgery.

In general, of course you're correct that much of orthopedic surgery is BS and not performed with an adequate evidence basis.

Interestingly, for many months after MY surgery I couldn't get back to hundred percent with my knee. I reluctantly accepted that I would probably have to quit surfing because I just couldn't pop up on my board. My surgeon said that under no circumstances should I undertake a strength training program that involved squatting. Fortunately, Paul Horn talked me into it and I did get to 100% within two weeks of working with him after suffering significant residual pain for months.

We'll never know if I could've gotten there without surgery in the first place. However, I seriously doubt that with the pain I was experiencing before surgery, I would've been able to tough it through even a broom handle squat.

I saw Paul because I read some book by a guy with shitty knees.
The vast majority of knee pain patients I have come through the clinic would not have met the exclusion criteria for the study. Most of my knee pain patients who are found to have a meniscus tear on MRI do not have symptoms matching a meniscus tear, nor do they have physical exam findings concerning for a symptomatic meniscus tear. That said, I have a lot of post-operative patients who were referred to ortho because of over-imaging by primary care and inability to properly assess a physical exam. Over-imaging results in blaming whatever symptoms the patient has on whatever is found abnormal on imaging. This holds true for the knee, the lumbar spine, shoulders, and essentially every other routinely imaged body part. Until a competent physical exam is done that demonstrates mechanical locking of the knee, one is simply guessing if his pain matches his MRI.

This is not to say that some people do not require arthroscopic debridement or a repair of a meniscus tear. If there are mechanical symptoms, one has virtually no choice but surgical debridement / repair. In the absence of such symptoms, it is likely no better than conservative management and the vast majority of the surgeons I work with will not even consider surgery for a meniscus tear without mechanical symptoms or without utter failure of conservative management.