Arthroscopy knee surgery

Arthroscopy knee surgery or chiropractic?

Arthroscopy knee surgery is the most common procedure for pain and osteoarthritis yet medicine's own research casts considerable doubt on the operation.

It is used for damaged ligaments and menisci, and osteoarthritis.

Our philosophy, and common sense too, recommends conservative care before such drastic measures are used.

A group of nearly two hundred patients with stubborn pain that would not respond to six months of medical treatment, were operated on by one highly experienced orthopaedic doctor; the US National Basketball Association surgeon.

Patients were divided into three groups; they were blinded, not knowing which procedure they would receive.

  • The lavage group was treated with 10 litres of fluid with minimal debridement.
  • The debridement group had all loose debris removed and the remaining meniscus was shaved, following by lavage.
  • A placebo group was treated with a sham operation in which the usual incisions were made, but no further treatment.

All three groups were treated with the exact same post operative care, and then followed for a two year period.

Real versus a sham procedure.

Arthroscopy knee surgery results were as follow.

The placebo group did better or, as well as, the lavage and debridement groups, both in terms of improved function and pain relief.

Or, to put it differently, at several times during the two year follow up period, the group operated with debridement did significantly worse than the placebo group.

Reference: Arthroscopic Surgery for Osteoarthritis of the knee, NEJM 374.

Arthroscopy knee surgery

Lateral knee pain

Lateral knee pain can be referred from the lower back, but more likely it's a friction rub syndrome of the ITB; a fairly frequent cause of non traumatic disability. It's not a surgical case. But first rule out torn ligaments or a damaged meniscus.

Noble's test would be positive and there would likely be tender trigger points down the ITB and in the TFL muscle belly. The straight leg raise of Lasegue would be negative.

More here about the iliotibial Band stretch exercise.

At this stage surgery is certainly not appropriate.

Perhaps you have read this. "A surgeon has admitted to performing a number of operations that don't yield results due to a widespread acceptance of the procedure and to avoid patient complaints and stop them complaining.

Ian Harris, a Sydney Orthopaedic surgeon, who works at a number of hospitals including the University of NSW, said he has performed surgeries on patients that don't work, reported the Sydney Morning Herald.

In a new book, Surgery, The Ultimate Placebo, Professor Harris has noted that the only benefits some surgeries provide is the 'placebo effect'."

Kneecap pain.

Patello femoral pain syndrome (PFPS)

Patello femoral pain syndrome is a common complaint in the practice. Usually it comes on after a fall onto the knee or after much stair or mountain climbing.

The cartilage on the under surface of the patella, as it is called, is prone to wear and tear. Calcium crystals collect causing a grinding sound; medicine's solution is arthroscopy knee surgery. 

PFPS also occurs in children. On a regular basis chiropractors are consulted with young people with sometimes severe and disabling kneecap pain.

The diagnosis for PFPS is done by Clarke's Test. It must be done very gently, because when positive it is very painful, and may aggravate the condition. PFPS is very treatable with chiropractic help. Research shows that a magnesium deficiency is often the culprit; spinach is one of the richest sources of the mineral.

Surgery may be used but, in my opinion, only as a last resort; it's possible that it's only benefit is the placebo effect. Mind you we chiropractors use it too.

Clarke's test

Clarke's test is performed on the straight leg. The knee cap is gently pressed onto the femur, and distracted towards the foot. The patient then very gently contacts the quadriceps muscle.

A full examination of the knee including Clarke's test is obviously called for before arthroscopy knee surgery.

IATROGENIC ILLNESS (doctor-caused disease)

Whilst no chiropractor could even contemplate that s/he could supplant the excellent orthopaedic surgeon, there is enough research to suggest that before going under the knife, a consultation with your chiropractor may be the sensible thing to do.

Hospital acquired infection alone during all surgery is not uncommon.


Chiropractic help

Chiropractic help for knee pain is a daily business in a busy practice.

Mr S, an 79 year old man consulted me yesterday after having had arthroscopy knee surgery after an unfortunate collision. His car hit a cow on the road in the dark, and his knee met the dashboard by accident. There was no immediate pain, but a week later it swelled up alarmingly.

A month later he went for arthroscopy knee surgery by one of the region's top orthopaedic surgeons, but to no avail. There was absolutely no improvement. He walks with a severe limp and a cane, having had no knee problems prior to the accident.

Yesterday, he had a severe show of black blood in the stool; a haemorrhage from the stomach of blood caused by the anti inflammatory drugs.

We'll see how he fares with Chiropractic care.

UPDATE: The initial response was excellent, about 60% less pain in two weeks. Then he went on holiday and I never saw him again until recently at a wedding. He's battling again.

I obviously never impressed on him the need for an occasional regular treatment. Otherwise, most severe and chronic conditions gradually relapse again. My fault! Plus he lives 130km away.

More stories from the CHIROPRACTIC COALFACE 2 ...


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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.