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New York Times (NYT) writer Jane Brody engaged in a lot of what she describes as "wishful thinking" about how best to treat her knee pain.

One surgery, 1 hyaluronic acid injection treatment, and 2 knee replacements later, she's wondering what might've been had she avoided interventions that "have limited or no evidence to support them."

In her July 3 NYT piece titled "What I Wish I'd Known About My Knees," Brody recounts her journey through meniscal tear arthroscopic surgery and "painful, costly injections," only to lead to knee replacement, and compares her results with a friend who opted for physical therapy when he was diagnosed with a meniscus tear and is now pain-free.

The stories highlight what Brody calls "serious questions" about the benefits of arthroscopic procedures people pursue "in hopes of delaying, if not avoiding, total knee replacements."

Brody cites recent guidelines, published in BMJ, that recommend conservative treatment over arthroscopic surgery for "nearly all" patients with degenerative knee disease. Brody quotes Reed A.C. Siemieniuk, MD, chair of the BMJ panel that created the new guidelines, as saying that "arthroscopic surgery has a role, but not for arthritis and meniscal tears," and that "[arthroscopic surgery for meniscal tears] became popular before there were studies to show that it works, and we now have high-quality evidence showing that it doesn't work."

In the article, Brody also summarizes Siemieniuk's recommendations on "approaches that are known to help keep many patients out of the operating room." In addition to weight loss, avoiding activities that aggravate the pain, and using over-the-counter pain relievers if necessary, Brody writes that "most helpful of all" is to "undergo 1 or more cycles of physical therapy administered by a licensed therapist, perhaps one who specializes in knee pain. Be sure to do the recommended exercises at home and continue to do them indefinitely lest their benefits dissipate."

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