Why Your MRI Doesn't Mean You Need Surgery | Dr Howard Luks

September 28, 2026

AI Summary

5 min read

Why Your MRI Doesn't Mean You Need Surgery

Dr. Howard Luks, an orthopedic surgeon who spent decades operating on knees and shoulders, now spends much of his clinical time talking people out of surgery. This shift came slowly. "When you're trained as a resident, you really don't get a lot of office time," he explains. "You don't see the hundred or so meniscus tears before them. So a lot of young surgeons tend to come out thinking from an MRI report perspective, this is torn, it can't be normal, it must need an operation." Over thirty years of practice, he learned otherwise.

What Imaging Actually Shows

The central problem, according to Luks, is that MRI findings that look alarming are actually normal for most adults. "Almost everyone over the age of 40, 45 is gonna have some degree of labral tearing. Almost everyone over the age of 40 has an identifiable rotator cuff pathology." As people move into their fifth, sixth, and seventh decades, full-thickness tears of one or more rotator cuff tendons "becomes the norm."

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What you'll learn

1 (00:04) **Why an Orthopedic Surgeon Started Questioning Surgery** - Dr. Luks describes his background and how he came to believe that many common MRI findings don't require an operation.
2 (04:09) **What Sham Surgery Studies Reveal About Common Procedures** - The evidence from sham-controlled trials and PT-comparison studies shows many surgeries don't outperform placebo.
3 (07:47) **Surgeries That Are Actually Worth It** - Dr. Luks identifies specific conditions where the evidence clearly supports surgery over conservative management.
4 (10:23) **Are Orthopedic Surgeons Incentivized to Operate?** - A direct look at the financial and systemic pressures that can influence surgical recommendations.
5 (14:50) **How AI Is Changing Patient Consultations** - Dr. Luks discusses the growing influence of AI on patient expectations and its potential to create unnecessary fear.
6 (16:07) **Normal Aging vs. Pathology: What Your MRI Actually Means** - A deep dive into the biology of tendons, ligaments, and joints, and why most findings are age-appropriate changes, not injuries.
7 (19:46) **The Power of Prehab: Preparing Your Body for Surgery** - Dr. Luks outlines how optimizing metabolic health before an operation dramatically improves outcomes.

+ Full timestamped outline available in the app

Show Notes

Howard Luks is an orthopaedic surgeon with almost 30 years of experience, and a good deal of his week is spent telling people they do not need an operation. We work through the joints that bring most people into a clinic, knees, shoulders, Achilles tendons and ankles, and separate what a scan is actually telling you from what it is being used to justify.

Almost everyone over 40 has something on an MRI that will be described as a tear. Very few of those people need surgery, and plenty have no pain at all. Howard's case, drawn from three decades in clinic and the sham-surgery and physiotherapy-controlled trials behind it, is that our language has raced ahead of the biology, and that the words we use change how people move and live.

What We Cover

Why "tear" and "bone on bone" are the wrong words, and what they do to a person's behaviour
What sham surgery trials showed for meniscus tears, rotator cuff tears and bone spur removal
How metabolic health shapes both your pain and your ability to heal after surgery
Why tendons respond to load rather than rest
Cortisone, PRP, stem cells and peptides: what the evidence supports and what is marketing
Ice, anti-inflammatories and ankle sprains, and why early movement beats a boot
Plyometrics, balance and power, and why they matter more than strength after 50

This is a conversation about being careful with language and honest about uncertainty, and about keeping your capacity so you can keep doing the things you care about.

To connect with Howard Luks, read his writing on Substack or find him on X and Instagram.

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