Wouldn't it be nice if every healthcare decision you had to make was straightforward -- and each decision was supported by verifiable and accurate data? The standard that physicians are held to today is that their recommendations should be based on evidence-based medicine. That is a standard vastly different from "this works for me." In this section I will cover some of the more controversial areas in orthopedic surgery -- areas I deal with on a daily basis. Email me at hjluks@howardluksmd.com to ask me to review a topic.

 

Do all meniscal (cartilage) tears require surgery?

Clearly the answer is no. Many patients have degenerative tears that will be symptomatic for only a short time. Rest, relax, and give your knee a few weeks to heal. If your pain persists, perhaps surgery should be considered. Please refer to the knee FAQ section for more information.

 

Do all rotator cuff tears need surgery?

Clearly the answer again is no. Some tears can't and shouldn't be repaired. Many small tears in patients over the age of 65 are attritional and probably just a consequence of aging. Most of these tears will respond to injection, rest, physical therapy, and medication. It can take as long as 5-7 months to fully recover from a rotator cuff repair. That is a huge commitment on your part. Consider looking at the Shared Decision Making section to see if surgery is the right answer for you. Please refer to the Shoulder FAQ section for more information.

 

"I have an ACL tear. I need surgery, right?"

Not necessarily. Nearly a third of all patients with an ACL tear will get around just fine without surgery. Patients with functional instability of the knee or a feeling of giving way are usually considered good candidates for a reconstruction. Refer to the KNEE FAQ section for more information.

 

I have a bone spur in my shoulder. Do I need surgery to have it removed?

This is a highly charged and very controversial topic in orthopedic surgery right now. Clearly the pendulum of Evidence Based Medicine is swinging toward the NO side of this discussion. It was once widely believed that if the spur was allowed to remain in the shoulder that you would develop a rotator cuff tear. Most academic surgeons no longer believe that to be true.

 

I dislocated my shoulder. Do I need to have it repaired?

Once again, very controversial. Most academic research shows that the redislocation rate hovers near or above 50 percent in patients under 21 years of age. In this age group, especially in a contact athlete, you could go either way -- surgery or no surgery. Many academics will recommend surgery. But you have a choice -- see the Shared Decision Making section. If you are over 21, most surgeons would agree that you should wait and see if the shoulder remains unstable after a period of immobilization with your arm externally rotated (Japanese data), followed by a trial of physical therapy.

 

I ruptured my Achilles Tendon and I have been scheduled for surgery; do I have other options?

You absolutely do have options. The two main options are operative and non-operative. You need to review the risks and benefits of both options -- they both have a high success rate for healing the tear. An infection is a risk only in the operative group. An infected Achilles tendon repair can be a disaster because of the relatively thin skin that covers he area. The risk of non-operative treatment is a higher re-rupture rate when compared with operatively treated injuries. So which do you choose? I have treated highly competitive athletes non-operatively, but inactive patients sometimes choose surgery. This is a perfect example of a situation in which a Shared Decision Making Process is necessary. 

 

I have Tennis Elbow (Lateral Epicondylitis) and I have been told I need surgery. Do I have other options? 

Tennis elbow involves degeneration of the tendons on the outer side of the elbow. This makes lifting objects and moving the elbow very painful. Some patients are severely affected, but others experience far less difficulty.

In many instances, tennis elbow is a self-limiting process and will resolve itself spontaneously. If the pain is very severe, a cortisone injection may be offered to eliminate the pain, but it will not cure the problem. Because a maximum of 2-3 injections can be given for this condition over a lifetime, most surgeons will not often inject patients. If the pain returns after surgery, and other non-operative alternatives are not successful, then surgery may be considered. Surgical options include both arthroscopic and open surgery. Both work very well, but the arthroscopic approach might allow you to return earlier to work and normal activity.

When the symptoms first occur, treatments such as ice, anti-inflammatories, stretching, and gentle compression should be tried before consulting a doctor.