Debride. ”De-breed” – from medicinenet.com ”To remove dead, contaminated, or adherent tissue and/or foreign material. To debride a wound is to remove all materials that may promote infection and impede healing. This may be done by enzymes (as with proteolytic enzymes), mechanical methods (as in a whirlpool), or sharp debridement (using intruments).”
It has been a common process for decades, to go into the knee, and to debride the tissue of a meniscus because it is torn, frayed… somehow distressed. It makes sense. You have a knee, it has some tissue in the way, it gets caught occasionally causing excruciating pain. It causes your knee to “freeze” in place at times, causing you to be pretty useless. I don’t discard the simple idea, and how smart it seems.
I do however, discard the effectiveness of this surgery relative to other possible treatments, simply because of what I have seen in the research. First, consider this. The average person who is going through a problem, an injury, a state of low health, a symptom of any type whatsoever that might exist in the body. When given a conservative treatment option, most will want to try it first. Avoiding drugs and surgery makes sense to people, but there is a problem. People don’t make good patients. We want to KNOW it is working now. We are fickle in our commitments, if things aren’t improving, we wonder why, and commitment wanes.
Now, on the flipside, what about surgery. A “quick” solution to the problem… relatively trusted outcomes… no real question that what is supposed to be done, is being done. The study, is a new one, that follows several others of the exact same style. Read through this short write-up from the NPR website:
The gold standard for medical research is a randomized controlled trial, but it’s hard to sign people up if they might undergo pretend surgery.
Researchers in Finland managed to persuade 160 people with knee pain and a suspected torn meniscus to sign up, not knowing if they’d get real or sham surgery.
Once they were in the operating room and under anesthesia, the doctors determined that 146 of the people were suitable candidates for an operation called partial meniscectomy, in which weak or loose parts of the meniscus are removed. Half of that group went on to have the surgery, while the other 76 were given sham surgery. Who got what was determined by a nurse, who opened an envelope in the operating room and showed the instructions to the surgeon.
Because many of the patients had epidural anesthesia and were awake during the surgery, the surgeons were called upon to exercise their theatrical talents. They asked for instruments, moved the knee as in real surgery, and pushed a shaver without a blade against the kneecap. The meniscus, a C-shaped piece of cartilage in the knee, pads the joint between the thighbone and shinbone. Tears, shown above, can be caused by twisting or by use over time.
The researchers then measured the participants’ knee pain and function one year later. There was no significant difference between the people who had real surgery and the ones who had sham surgery. And there was no difference between the groups in terms of serious complications or the need for additional knee surgery. http://www.npr.org/sections/health-shots/2013/12/26/257350215/common-knee-surgery-may-help-no-more-than-a-fake-operation
In a prior study, they found that the sham surgery patients actually did better. Interesting outcomes. Now consider this… for the person we described above who likes the idea of conservative management, but they just don’t get a good enough response. Lets say that those people are using physical therapy to attempt to get well… but it isn’t working. Well, how do we know it isn’t working? Because the patient did 50% of the PT at 50% of the PT visits? That’s probably being generous actually.
But what about post surgery? The average patient will rest the required amount of time, and perform upwards of 70% of the PT that is prescribed… because they are scared to screw up the surgery. You see… if you just DID the conservative treatment to its completion, you would likely have had the best outcome already… but for many, it takes the fear of messing something up that was 1. Expensive and 2. Risky, in order to get compliance out of a patient.
The simple story of this study is, follow conservative treatment to its entirety to get the best result, period.
Be well and be blessed! - Dr. E