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When health practitioners bemoan the gap between the scientific evidence base and the real world, it is usually with a belief that patients or policymakers are failing to heed advice of established medical science. Occasionally, we need to concede that the medical profession can sometimes fall behind the scientifically established evidence base.
The evidence base for knee arthroscopy
The most common orthopaedic procedure in the UK, the USA and elsewhere, is knee arthroscopy. This revolutionary 1980s procedure transformed knee surgery as it slashed surgical recovery time from months to weeks. It took 20 years for the first high-quality studies to assess whether knee arthroscopy was actually efficacious for its most common indications, and these results did not favour surgery.1 Multiple randomised controlled trials since, comparing knee arthroscopy in middle-aged arthritic knees (with or without meniscectomy) with another treatment (sham surgery or conservative treatment)2–5 have …