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UB study challenges long-standing knee surgical technique

University at Buffalo researchers say their new study challenges a surgical practice used for decades during arthroscopic knee surgery.

When treating meniscal tears -- a common orthopedic procedure of the cartilage cushion that can break down with age or trauma -- surgeons also have clipped and smoothed dislodged cartilage in the belief it helped patients. But the study in the Journal of Bone & Joint Surgery found that the practice does not benefit patients. Patients who did not have dislodged cartilage removed, recovered faster, with less pain, and ended up a year later with identical results, the researchers concluded.

“Those with less surgery got better faster in comparison with the people we did more surgery on,” Dr. Leslie J. Bisson, professor and chair in the Department of Orthopaedics at the Jacobs School of Medicine and Biomedical Sciences and lead author, said in a statement.

Doctors check for arthritis -- the tearing or dislodgement of cartilage called chondral lesions -- using X-rays when they are preparing to treat a meniscus in the knee. But low-level arthritis may not be visible, and doctors find it only when they are inside the knee. At that point, Bisson said, doctors have always opted to clip and smooth any loose cartilage.

The study followed 98 patients who had dislodged cartilage removed and 92 who did not. Both groups had the same results one year after surgery, and the group without what's known as debridement had less pain and better function during recovery.

“That was very surprising to us,” he said.

Bisson said the surgeons at UBMD Orthopaedics & Sports Medicine, where he and the other doctors involved in the study work, are no longer debriding knee cartilage when repairing meniscal tears. They perform about 1,000 of the procedures each year.

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