Rethinking Knee Surgery: Insights & Regrets from a Doctor

Authored by: Dr. Niteesh Bharara

As Director of Regenerative Medicine at VSI, I help patients every day who are dealing with terrible back, neck and body pain. When surgery isn’t the right answer — or isn’t possible — regenerative medicine procedures like platelet rich plasma or stem cell therapy often comes into play to help the body promote its own healing.

Ensuring that patients know about non-operative procedures that could work for them is incredibly important to me because before I was a doctor, I was a patient. As a teen, I needed knee surgery and if I knew then what I know now, I would never have undergone the procedure. Here is my surgery story and five things I wish I had known that I make sure all my patients know now to truly understand their options.

My Surgery Story

I was an avid soccer player as a teen and one day, when I was 16, I got tackled on the field, broke my leg and tore my meniscus. Luckily I didn’t need surgery but I was in a cast for a while. Once my fracture healed, I was still having a lot of knee pain. Doctors ordered an MRI and when they saw the meniscus tear, an orthopedic surgeon ordered surgery sooner rather than later.

My parents are both scientists and I do remember them asking questions — but it was more about what the procedure and my recovery would look like. We didn’t realize there were options at the time. None were presented to us.

Surgery was terrible. It was very challenging. They removed part of my meniscus and I never fully got better. I was referred to another surgeon who did another knee surgery a year later when I was 17. And then I had a third knee surgery later that year, right before I turned 18. It all made a little bit of a difference but I never got back to where I had been before the injury or procedures.

Now look — I’m not faulting my parents — or myself, about the decisions we made. We just didn’t understand that there was anything else we could ask about to heal my injury. And while this experience happened many years ago, it’s something that countless numbers of my patients still go through today. Very often, surgery is the only option presented to patients and they come to me wondering if there is anything else they can do.

Often there is. Here are five things I wish I knew — and want all my patients to know — as they explore what, if any other options they have beyond surgery.

#1 — Always ask about your options

Anytime you have an injury to your body or any pain symptoms, especially musculoskeletal, start by confirming your diagnosis. And whether or not they’re presented to you — always ask if there are potential options for your treatment.

In particular, ask about physical therapy — it’s a great place to start for many patients experiencing pain and injury because it helps with pain, strength, healing and so much more. It builds better habits too that can keep you from reinjuring yourself.

As a Regenerative Medicine doctor, I encourage you to explore regenerative medicine options too. Regenerative medicine includes modern non-operative treatment solutions that utilize the body’s natural healing process to rebuild damaged tissue, heal injuries more effectively, and eliminate pain. Regenerative medicine targets the underlying source of pain without relying on medication or surgery and leads to increased function and mobility with a shorter recovery time than surgical options. These are safe and effective outpatient procedures that can be useful to address injuries in a variety of joint, tendon, ligament, and spinal conditions.

#2 — Seek opinions from surgical and non-surgical practitioners.

There’s an old saying that surgeons will always recommend surgery. That’s certainly not the case in our practice, where 90% of patients get better without surgery. But it is something I hear over and over again from patients coming to us for second opinions. Look — surgeons understand surgery. So it’s good to talk with one and see what they recommend. I think you should then also talk with someone who focuses on non-operative solutions and see what they suggest to address your pain or injury. I think it’s very helpful for patients to get both of those views. Sometimes they will align and sometimes they won’t. But getting this range of perspectives will likely help you determine what’s best for you.

#3 — Recognize that sometimes it’s not about which option you do — but which one you do first.

There are times regenerative medicine isn’t an option for people. There are also many times it’s the first thing we try, before surgery — to see if it brings about improvement before a patient commits to a more involved surgery. If you can get better with a non-surgical solution, most people want to at least try that. If it works — great. If it doesn’t, at least you know you exhausted all options before committing to something more invasive.

#4 — Ask for data

I hear all the time from patients who come and see me that their orthopedic surgeon says there’s no data showing regenerative medicine techniques like stem cell or PRP or adipose fat injections actually work and that just isn’t true. The field is moving fast but we have plenty of data now showing the efficacy of these procedures. Surgeons do surgery so of course they know the data on that. I also recommend asking a non-surgical expert for the data they have so you get the full picture. I can tell you that I’m very knowledgeable and not only do I do a lot of research in the field myself — but can also share a lot of data on non-surgical regenerative options.

#5 — Factor in function when judging improvement

MRIs and other scans are important to highlight structural issues and injuries — but they don’t always tell the whole story. MRI changes are sometimes visible when patients improve, but not always. It depends on what you’re treating. That’s why I think it’s important to factor in function too. If you’re treating osteoarthritis of a knee joint, for example, you may not notice a change in the structure of the knee itself when you do regenerative medicine. But a patient will certainly notice when their knee no longer swells, isn’t painful or unstable anymore and they can now run again.

Back to my personal story, years went by and I did a lot of physical therapy and then, once I became familiar with regenerative medicine, I used it three times on my knee. PRP helped with the osteoarthritis I’ve developed because of the three scopes done on my knee. It’s improved the instability my knee has long had as well. I’ve seen great outcomes. I’ve been able to play basketball and soccer again without my knee blowing up or having a lot of swelling. So it’s worked for me.

I’ve also gone back and looked at my MRI and knowing what I know now, I can tell you if I had the choice to make today — I would not get surgery. Specifically with meniscus tears, which was my injury, there’s a lot of data and research showing better outcomes with non-surgical treatment than going under the knife. It’s too late for me to make a different decision for myself but it’s very important to me that my patients know, when and if they have to make a big decision of their own, that in this modern age of medicine, they do in fact have options.

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