A new study in JAMA surgery by Johns Hopkins surgeon Dr. Martin Makary has shown that arthroscopic surgery to trim the cartilaginous meniscus was no better than non-operative treatment for patients in their 60s. This is something that has been written about before and as a result I very rarely perform meniscectomy in patient who are older and have arthritis. PRP and stem cell treatments have proven to be a fantastic treatment for such patients. They are generally effective, non-invasive and less expensive. For this reason it is almost always my first option. If it is not effective and if an older patient has a youthful knee with a good standing x-ray joint space and little arthritis then arthroscopy can sometimes be beneficial. Such patients should also have “mechanical” symptoms of something being unstable in the knee. I had one 80 year old retired university professor from Wisconsin with such a knee who had excellent results from arthroscopy. But such patients are few and far in between. Indeed I have to explain to patients who are seeking surgery that just because the cartilage is torn does not mean that removing it will improve their knee. In fact in arthritic knees removing damaged but functioning cartilage can make patients worse and accelerate their decline toward knee replacement. Even though I am a specialized arthroscopic knee and shoulder surgeon, I have always tried to reserve surgery as a last resort. This study provides further validation that for older patients this is indeed the proper course. Furthermore PRP and stem cell injections do not burn bridges and surgery, whether arthroscopic or knee replacement can always be carried out later if need be.