Well, far be it from me to say ‘I told you’, but, I told you so!
Let’s re-wind the clock. Back in the early days of rationalbrain, I put the spotlight on this popular supplement, given my own personal interest in keeping my knees in good order after a lifetime of pounding roads, basketball courts, football grounds, and aths tracks. (My knees are actually quite close to my heart – no, I’m not crouching, nor am I mis-shapen; I’m just quite fond of them).
At the time, this fledgling skeptic concluded that:
Basically, the high quality studies show no improvement over placebo, while the lower quality ones show a 2 point improvement in pain on a scale of 68! Talk about marginal effects. That’s certainly not enough for me to be sucking these things down, even if they are harmless.
Smarties would be cheaper, tastier, and about as effective.
The thing I found most remarkable at the time was that even those who should know better were sucked into the Glucosamine fad: my local GP (who specialises in sports medicine), and, the surgeon who did my knee arthroscopy ops. When I asked the former what the supporting research was, he coyly admitted he didn’t know, and pointed me to the Cochrane Reviews, on which I’ve been relying ever since, and from which the above conclusion came.
There have been other studies which concluded similar things, most of which have been reviewed by Harriet Hall over at the excellent Science Based Medicine blog.
And now, almost 3 years later, there’s a new study to talk about, which also concludes the same thing, but which is also remarkable for another reason.
The study was conducted by the American Academy of Orthopaedic Surgeons (AAOS). I’ll leave the remarkable bit for now. But this was a huge review of the literature for all treatments for osteoarthritis of the knee (which is the ‘wear and tear’ variety that we all suffer in the later years, especially us super-athletes, right?).
They managed to condense the 1200 page report (no, I haven’t read it all), into a handy 13 page summary, which you can read for yourself here.
The work basically rates the various treatments for efficacy. Harriet Hall has summarised the conclusions further as follows, with those items showing strong evidence one way or the other highlighted:
- Exercise – strong evidence for effectiveness
- Weight loss – moderate evidence for
- Acupuncture – strong evidence against
- Physical agents (TENS, ultrasound, etc.) – inconclusive
- Manual therapy (chiropractic, massage) – inconclusive
- Valgus-directing force brace – inconclusive
- Lateral wedge insoles – moderate evidence against
- Glucosamine and chondroitin – strong evidence against
- NSAIDs – strong evidence for
- Acetaminophen, opioids, pain patches – inconclusive (this is particularly interesting since acetaminophen is the standard first-choice drug)
- Intraarticular corticosteroid injections – inconclusive
- Hyaluronic acid injections – strong evidence against (and if injections are ineffective, those oral diet supplements certainly don’t have a chance)
- Growth factor injections and/or platelet-rich plasma – inconclusive
- Needle lavage – moderate evidence against
- Arthroscopy with lavage and debridement – strong evidence against
- Partial meniscectomy in osteoarthritis patients with torn meniscus – inconclusive
- Valgus-producing proximal tibial osteotomy – limited evidence
- Free-floating interpositional device – no evidence; consensus against
There’s a number of really interesting things here.
- Firstly, the no-brainer: acupuncture is useless. Quelle surprise!
- Secondly, glucosamine and chondroitin – now it’s strong evidence against (hence my ‘I told you so’)
- Thirdly, NSAIDS (i.e. non-steroidal anti-inflammatories) like neurofen etc – strong evidence for.
- Fourthly, exercise is good for you. Who knew? I’ll have more to say on this in a sec.
- And finally, the shock for me: arthroscopy (the other bit is the trim and vacuum of the bits of cartilage), which I’ve had done a couple of times – seems to be strong evidence against.
While it’s comforting to have my earlier conclusions about glucosamine supported so strongly, I do have to acknowledge that I was/am a great believer in arthroscopy, because of the success I’ve had with it. But I’m prepared to reconsider that belief, not only because of this study, but because of my own more recent experience.
I did have a couple of arthroscopy sessions, separated by about 10 years, to get rid of those niggling knee pains. And they worked fine – back to running and basketball within 2-3 weeks. But a few years back, after feeling more knee pains now and then, I concluded I needed another knee ‘tune up’. The only problem was that my doctor disagreed. He didn’t think the wear and tear was bad enough to warrant it, and eventually talked me out of it, suggesting instead that I should do more knee exercises. That didn’t appeal too much – I’d prefer a quick fix to ongoing physio anytime.
However, I embarked on daily leg exercises – mostly straight leg with weights. Lo and behold, it worked.
So, while I was quite convinced that arthroscopy was the bees-knees (sorry, couldn’t resist), it turns out that perhaps there was another way – which is in fact what this study found.
And what was the remarkable thing I mentioned at the top of this post? That the AAOS has found AGAINST one of the biggest money-earners of their entire profession – knee arthroscopy, which at least in Australia is a huge industry. So congrats to the AAOS for being frank and fearless in their research, and letting the facts speak, instead of yielding to self-interest.
It’s also a good example to set for those alternative therapy hypocrites who constantly accuse the medical establishment of being in it for the money.