BMJ RapidRecs guideline warns against arthroscopy for most patients with degenerative knee damage

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The new clinical practice guideline was developed under the BMJ Rapid Recommendation project.

An international panel of experts has strongly recommended against the use of arthroscopy in nearly all patients with degenerative knee disease.

Most guidelines continue to support the use of arthroscopy in key subgroups. However, a randomised controlled trial published in the BMJ  in June 2016 found that, among patients with degenerative medial meniscus tear, outcomes with knee arthroscopy were no better than those seen with exercise therapy.

The findings prompting a panel to be convened to review all current relevant research on the issue. The resulting Rapid Recommendation  has concluded that arthroscopy does not, on average, result in lasting improvement in pain or function.

Given that there is evidence of harm and no evidence of important lasting benefit in any subgroup, “the panel believes that the burden of proof rests with those who suggest benefit for any other particular subgroup before arthroscopic surgery is routinely performed in any sub-group of patients”.

The new clinical practice guideline was developed under the BMJ Rapid Recommendation project, which aims to have synopses and decision-support tools available to clinicians within 90 days of identification of potentially practice-changing evidence.

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