When is Surgery Necessary When Treating Injury?
Whether it's a traumatic acute injury or a chronic one that builds up over time, surgery is often cited as the way to go in terms of treatment.
And while surgery may be necessary depending on the severity of the injury and the prognosis, we often jump to it too quickly.
One study on knee meniscal tears found that exercise and education were just as effective as surgery when it came to clinical improvements in pain, function, and quality of life. (5) These were for tears of the more traumatic fashion as experienced commonly during sport.
Another study found that even with more chronic degenerative conditions, there was no greater benefit to surgery compared to exercise. (4)
Especially if the surgery involves some permanent loss of function, we need to emphasize non-operative options to people.
For example, severe low back pain due to degenerative spinal and disc issues is often treated with spinal fusion surgery. And once you do this, you lose mobility in the spine forever. Unfortunately, just as with the meniscus of the knee, this low back surgery has shown no greater effectiveness than exercise and education.
A study found that after 11 years of follow-up, there was no difference in outcomes between fusion and exercise rehabilitation. The study also cites that given the increased risks of surgery and lack of deterioration in patients who simply exercise, spinal fusion surgery should not be favoured by health care professionals where proper rehab programs are available. (1)
Going back to the knees, another study compared knee surgery to a placebo surgery, aka a "fake" surgery. And still, they found no difference in outcomes. (3)
Even as I cite these, it does not mean I recommend avoiding surgery at all costs. I just prefer people to be educated on the effects of surgery as opposed to just building up strength over time in the joint.
This is especially important if you are being recommended surgery right off the bat without trying any other options. We, unfortunately, get some images done, and based on that are told we need surgical repair.
But here's the big problem with that.
A study found that there was meniscal pathology in a large number of asymptomatic athletes. And as we age, we find a rising number of disc bulges on imaging scans as well, but they also don't correlate well to actual pain and loss of function. (2)
Meaning that there are plenty of people walking around with disc bulges and meniscal pathology according to imaging results, but are often just fine and don't need intervention. But they would be prime candidates for surgery.
People deserve to know that there are lower-risk, lower-cost options that research has shown to be just as effective for injury treatment.
To your good health,
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I help people all over the world regardless of location to build sustainable strength while leaving aches and pains behind.
1. Anne F.MannionPhDaJens IvarBroxMD, PhDbJeremy C.T.FairbankMD, FRCSc. Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. The Spine Journal. 13(11): 1438-1448.
2. Beals, C.T., Magnussen, R.A., Graham, W.C. et al. The Prevalence of Meniscal Pathology in Asymptomatic Athletes. Sports Med 46, 1517–1524 (2016). https://doi.org/10.1007/s40279-016-0540-y
3. J. Bruce Moseley, M.D., Kimberly O'Malley, Ph.D., Nancy J. Petersen, Ph.D., Terri J. Menke, Ph.D., Baruch A. Brody, Ph.D., David H. Kuykendall, Ph.D., John C. Hollingsworth, Dr.P.H., Carol M. Ashton, M.D., M.P.H., and Nelda P. Wray, M.D., M.P.H. A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. N Engl J Med 2002; 347:81-88. DOI: 10.1056/NEJMoa013259
4. Jeffrey N. Katz, M.D., Robert H. Brophy, M.D., Christine E. Chaisson, M.P.H., Leigh de Chaves, P.T., O.C.S., Brian J. Cole, M.D., M.B.A., Diane L. Dahm, M.D., Laurel A. Donnell-Fink, M.P.H., Ali Guermazi, M.D., Ph.D., Amanda K. Haas, M.A., Morgan H. Jones, M.D., M.P.H., Bruce A. Levy, M.D., Lisa A. Mandl, M.D., M.P.H., et al. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. N Engl J Med 2013; 368:1675-1684.
5. Søren T. Skou, Ph.D., Per Hölmich, D.M.Sc., Martin Lind, Ph.D., Hans Peter Jensen, M.D., Carsten Jensen, Ph.D., Mette Garval, M.Sc., and Jonas B. Thorlund, Ph.D. Early Surgery or Exercise and Education for Meniscal Tears in Young Adults. NEJM Evid 2022; 1 (2) DOI:https://doi.org/10.1056/EVIDoa2100038