IN REPLY: We thank Adams for providing private health insurance data that confirm the continued use of arthroscopic surgery for patients with osteoarthritis. We agree that the patient?s view of the benefits of the procedure is fundamental to assessing treatment success. We do not doubt that many patients are happy with the results of arthroscopic knee surgery, but this does not necessarily imply that the surgery has had any specific effect, as satisfaction rates are high after many ineffective placebo treatments. Indeed, high-quality randomised controlled trials have consistently failed to demonstrate clinically relevant self-assessed benefits of arthroscopy compared with sham surgery1 or non-surgical comparators.2-4 Potential risks of arthroscopy are also an important consideration. These include thrombosis, infection, complications of anaesthesia, and increased progression of osteoarthritis and likelihood of joint replacement.5 Satisfaction surveys do not justify the ongoing use of ineffective interventions. While some may find it acceptable to fund care based on perceived effectiveness, in this instance to do so might be doing more harm than good.