A 10-year study published in April in the New England Journal of Medicine found that arthroscopic knee surgery for degenerative cartilage tears provided little or no benefit and was associated with accelerated osteoarthritis and higher rates of reoperation. The findings have prompted renewed scrutiny of a procedure that remains common in the United States despite declining use in other countries.

The study followed patients who were middle-aged or older, experiencing knee pain, and whose MRIs showed cartilage tears. Participants received either arthroscopic knee surgery to trim degenerative cartilage tears or sham surgery consisting of a skin incision. The results showed that the surgery not only failed to improve outcomes but also left many patients worse off, with more pain and faster progression of joint degeneration. “What has been shown dramatically is that patients who have this procedure have more pain — they do worse,” said Teppo Järvinen, orthopedist and head of the Finnish center for Evidence-Based Orthopaedics. He added, “All the scores pointed in the same direction.”

Järvinen emphasized that the study was the first to demonstrate the procedure’s potential to harm patients over the long term. He noted the findings do not apply to cartilage tears caused by acute, traumatic injuries. “Nothing supports the idea that a patient's pain comes from the meniscus,” he said. “I don't know how I would defend this procedure at all.” In Finland, where Järvinen practices, arthroscopic surgery rates have dropped by 90% in response to accumulating evidence against its efficacy for degenerative conditions.

Despite such trends abroad, the procedure remains widely performed in the U.S. A study of commercial insurance claims counted over 2 million meniscus surgeries from 2010 to 2020, though the number declined by about 4% annually during that period. Most procedures were performed on women and patients in their 50s. In the traditional Medicare fee-for-service program, the number of arthroscopic knee surgeries fell from about 169,000 in 2014 to 91,000 in 2024. However, these figures exclude beneficiaries in Medicare Advantage plans, which now cover more than half of all Medicare enrollees. Geographic disparities persist: surgery for meniscus tears is more common in the South than in the Northeast among Medicare patients.

Some orthopedic specialists continue to support limited use of the surgery. “Many patients do benefit,” said Robert Brophy, director of the Orthopaedic Clinical Research Center at Washington University in St. Louis. He acknowledged that current practice among his peers is varied and added, “Evidence is growing for judicious use of this surgery in this population.” Last summer, a committee of orthopedic societies in Europe and the U.S. issued a consensus statement noting that degenerative meniscus lesions can be treated with comparable results using either non-operative approaches, such as physical therapy, or surgical methods.

The first-line therapy for a painful knee with degenerative tears is physical therapy and, for some patients, weight loss. Steroid injections have proved scientifically valuable for short-term pain relief. Other treatments like stem cell and plasma-rich protein injections are widely offered but not covered by most insurance, and studies on their effectiveness have been inconclusive. Orthopedists are also highlighting a newer procedure that involves sewing torn cartilage back together, though this is typically reserved for patients under 50 with acute injuries and clean tears, and it remains unclear which patients might truly benefit.

Arthroscopic knee surgery takes 30 to 60 minutes in the operating room, with patients spending a few hours recovering in a surgery center or hospital outpatient department. Medicare pays an average of $2,159 to $3,875 for the procedure, depending on location, and patients pay 20% as coinsurance. Commercial insurers pay well more than twice the Medicare rate, according to Marcus Dorstel, a senior vice president at the data analytics firm Turquoise Health. Provider charges vary widely and do not include surgeon or anesthesiologist fees.

Järvinen suggested financial incentives may influence treatment decisions. In the U.S., physician payments are determined by the Relative Value Scale Update Committee (RUC), a body of the American Medical Association composed largely of specialists. The AMA also owns the billing codes used to calculate patient charges. Fifty years ago, doctors considered cartilage a useless, vestigial tissue and routinely removed it entirely when tears were found. Today, when other treatments fail, knee replacement remains an option for chronic pain.

Why It Matters

The study’s findings challenge a long-standing surgical practice performed millions of times in the U.S. despite mounting evidence of its ineffectiveness and potential harm for degenerative knee conditions. With Medicare and commercial insurers spending billions annually on the procedure, the results raise questions about value, patient outcomes, and the influence of payment systems on clinical decisions. Experts note that non-surgical alternatives offer comparable relief without the risks of surgery or accelerated joint damage.