Is Standard Medical Care Always Better?

Do you know not all standard medical procedures and surgeries are supported by research data? Take for example arthroscopic knee surgery, the number-one most common orthopaedic operation. More than two million are done annually  and yet sham operative studies and other research have demonstrated it offers no advantage for most knee pain patients (Scientific American, 2018). Other surgeries, including those for low back pain have come under fire for being harmful and useless (The Sydney Morning Herald, 2018) and is a significant contributor to increasing health care costs (The Conversation, 2018)!


Runner's Knee

There has been a lot of media coverage questioning common, standard medical procedures. The issue in concern is that these procedures’ effectiveness are not supported by research data.

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Tendinopathy

Tendon pathology is a widely researched and discussed topic, and a quick google search can end up taking you down a deep dark rabbit hole of conflicting research, opinion, and debate.

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Do you know that knee pain is the most common pain complaint in older adults? Family Practice, Oxford University (2007)

Musculoskeletal pain affects up to 44 per cent of Singaporeans (The Straits times, 2015) and the number of people with knee pain has doubled since World War II (Science, 2017). But is surgery the solution to your problem?

All You Need to Know

It depends on what type.

A study by prestigious journal Pain Medicine in 2017 found that fake orthopaedic surgeries (including knee surgeries) were as effective as real surgeries in reducing pain and improving disability! Given the case, how do we know real surgery actually work? Placebo perhaps?

Always ask the surgeon for references to support his or her claims. If you need a second opinion, talk to us.

Reference:

Yes, it’s an absolute yes!

Surgery comes with its own set of risks and challenges you can avoid by choosing rehabilitation. In a 2018 study, meniscectomy was found to be strongly associated with the progression of articular cartilage damage. In a second 2018 study, 80% of patients who had undergone knee surgery suffered from knee arthritis compared to 68% in the group who did not have surgery.

Risks aside, surgery is not superior to rehabilitation. Patients who had ACL (anterior cruciate ligament) reconstruction did not yield better results than rehab alone at 5-year follow up. Sure, you tore your ACL but do you need it reconstructed? May not.

Reference:

This is a tough question. We strongly suggest patients with ACL injuries to seek conservative care BEFORE considering surgery.

Why?

Only 80% of ACL reconstruction patients return to some form of sports. 65% will return to a sporting level comparable to pre-injury, and a mere 55% return to play at a competitive level.

Reference: Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery in British Journal of Sports Medicine

At least nine months after your surgery.

39% of patients who underwent surgery and returned to sport earlier than nine months re-injured their ACL. That study concluded that for every one month delay in returning to sport, the injury rate was reduced by 51%.

While ACL surgery remains a legitimate option for patients with ACL injuries, rehabilitation remains the safer choice. In patients who have had undergone ACL repairs, extra effort must be taken to prevent further injury.

Reference: Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction in British Journal of Sports Medicine