A study published in the British Medical Journal in March 2020 revealed a significant decline in arthroscopic surgeries in Finland between 1999 and 2016. Knee and shoulder arthroscopy peaked around 2006 and has steadily declined since, while hip, wrist and elbow arthroscopy peaked later, around 2014, before beginning a similar downward trend.
The decline hasn't been as dramatic in the United States, but the data still show a noticeable "flattening of the curve" (forgive the timing) starting around 2008. The total number of arthroscopic procedures hasn't decreased, but the rate of increase has slowed significantly. So what explains this shift?
What the research really shows
The uncomfortable truth is that most arthroscopic procedures show equal or worse outcomes compared with sham surgery or structured physical therapy. Studies consistently show that conditions such as meniscus tears, labral tears, rotator cuff tears and subacromial decompression cases often don't require surgery.
With proper rehabilitation, patient education and guided exercise, outcomes are frequently similar to, or better than, those achieved through surgery. Over the past decade, high-quality research has reinforced the idea that the body often adapts better to healing injured tissue than to having that tissue removed. (For shoulder tears specifically, see operative vs. non-operative treatment of rotator cuff tears.)
Why surgery isn't always the best option
Surgery may sound like the fastest solution, but the reality is often the opposite. Removing tissue can disrupt natural joint mechanics and lead to long-term consequences, while conservative treatment lets the body adapt and recover while preserving joint integrity.
There are exceptions. Large meniscus or labral tears caused by acute trauma, particularly those that cause the joint to lock or feel unstable, may still need surgical repair. These cases, however, represent a minority of patients.
Surgery should be a last resort
For most people, especially active people, some wear and tear is inevitable over a lifetime. Pain doesn't automatically mean damage, and damage doesn't automatically require surgery. Before committing to an arthroscopic procedure, it's wise to consult a qualified rehab specialist and explore non-surgical options. In many cases, avoiding surgery leads to better short- and long-term outcomes, fewer complications and a faster return to activity.
Weighing arthroscopic surgery for your knee, shoulder or hip? Our physical therapists can walk you through your non-surgical options first.
book a sessionthe takeaway
Arthroscopic surgery rates have fallen or slowed as research shows that rehab often matches or beats surgery for meniscus, labral and rotator cuff tears. Traumatic tears that lock or destabilize a joint may still need repair, but for most people, surgery should be a last resort, not the first step.
Frequently asked questions
Do I need arthroscopic surgery for a meniscus tear?
Often not. Research shows that for many meniscus, labral and rotator cuff tears, physical therapy produces outcomes similar to or better than surgery. Large traumatic tears that cause locking or instability may be the exception.
Why are fewer arthroscopic surgeries being done?
A growing body of research shows many arthroscopic procedures perform no better than sham surgery or structured physical therapy, and knee and shoulder arthroscopy rates in Finland have declined since about 2006.
When is arthroscopic surgery necessary?
Large meniscus or labral tears from acute trauma, especially those causing joint locking or instability, may still require surgical repair.
What should I do before agreeing to surgery?
Consult a qualified rehab specialist and explore non-surgical options. Pain doesn't automatically mean damage, and damage doesn't automatically require surgery.
