Category: Knee

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Romina Brignardello-Petersen et al., BMJ 2017,

Knee arthroscopy versus conservative management in patients with
degenerative knee disease: a systematic review

Over the long term, patients who undergo knee arthroscopy versus those who receive conservative management strategies do not have important benefits in pain or function.

Patients and their healthcare providers must trade-off the marginal
short-term benefits against the burden of the surgical procedure (pain, swelling, limited mobility, restriction of activities, over a period of 2–6 weeks).

Raine Sihvonen et al. 2017,

Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial

Arthroscopic partial meniscectomy (APM) is one of the most common orthopaedic operations, with an incidence that has increased steadily from 1990s until late 2010s. Most APMs are carried out in middle-aged and older patients with knee symptoms and degenerative knee disease. Several recent
meta-analyses based on randomised controlled trials (RCTs) have failed to show a treatment-benefit of APM over conservative treatment or placebo
surgery for these patients.

Conclusion:

In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after
APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or
those who have failed initial conservative treatment are more likely to benefit from APM.

Reed A C Siemieniuk, 2017,

Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline

Approximately 25% of people older than 50 years experience knee pain from degenerative knee disease.

What is degenerative knee disease?

Knee disease is an inclusive term, which many consider synonymous with osteoarthritis. We use the term degenerative knee disease to explicitly include patients with knee pain, particularly if they are >35 years
old, with or without:

• Imaging evidence of osteoarthritis (OA)

• Meniscus tears

• Locking, clicking, or other mechanical symptoms except persistent objective locked knee

• Acute or subacute onset of symptoms

Most people with degenerative arthritis have at least one of these characteristics. The term degenerative knee disease does not include patients having recent debut of their symptoms after a major knee trauma with acute onset of joint swelling (such as haemarthrosis).

Management options include weight loss if overweight, a variety of interventions led by physical therapists, exercise, oral or topical pain medications such as non-steroidal anti-inflammatory drugs, intraarticular corticosteroid and other injections, arthroscopic knee surgery, and knee replacement or osteotomy.

What you need to know

There is a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on systematic reviews. This recommendation applies to patients with or without imaging evidence of osteoarthritis, mechanical symptoms, or sudden symptom onset.

Arthroscopic knee surgery for degenerative knee disease is the most common orthopaedic procedure in countries with available data and on a global scale is performed more than two million times each year. Arthroscopic procedures for degenerative knee disease cost more than $3bn per year in the US alone.

Osteoarthritis (OA) is the most common form of arthritis, affecting an estimated 302 million people worldwide, and is a leading cause of disability among older adults. The knees, and hips, are the most commonly affected joints. OA leads to pain, stiffness, swelling, and loss of normal joint function (2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee).

Recommendations for physical, psychosocial, and mind-body approaches for the management of osteoarthritis of the knee, and hip.

Strongly recommended: Exercise, Weight loss, Tai Chi, Knee brace (tibiofemoral knee brace), Cane, Self-efficacy and self-management programs.

Conditionally recommended: Yoga (for the knee), Cognitive Behavioral Therapy, Balance Training, Patellofemoral Braces, Acupuncture, Thermal Interventions, Kinesiotaping (for the knee).

Strongly recommeded against: TENS (transcutaneous electrical nerve stimulation)

Conditionally recommeded agaist: Modified Shoes, Wedged Insoles, Massage, Manual Therapy with / without exercise, Pulsed Vibration Therapy

Knee X-ray and Pain

Radiographs have long been considered as the reference standard for the assessment of OA, for more than four decades. To date, the majority of studies have reported that radiographic OA (ROA) is poorly correlated with knee symptoms, and most risk factors for ROA are not strong predictors of knee pain. Pain perception is complex, however, and knee pain is frequently associated with non-OA variables, such as psychosocial factors, education, economic statusas well as local pathology (Radiographic Knee Osteoarthritisand Knee Pain: Cross-sectionalstudy from Five Diferent Racial/Ethnic Populations 2018).

Running does not increase symptoms or structural progression in people with knee osteoarthritis – Tom Goom (Physio Network 2018)

“We can help reassure such people that they can continue to run without fear and that it may even lead to improvement in sympom“.

The current research in OA suggests 3 important things:

1. Arthritic change within knee joints is very common even in those without pain, for example a study from Geurmazi et al. 2012, found 68% of people with no pain had evidence of cartilage damage on MRI.
2. Running doesn’t appear to increase the risk of developing hip or knee arthritis.
3. Running with knee OA doesn’t seem to hasten disease progression or worsen symptoms over a period of time.

Prescribed Exercise For Knee Osteoarthritis Via Skype? – R. S. HINMAN et al. 2017, American College of Rheumatology ( article reviewed by Dr Jarod Hall, Physio Network)

Key points

• The finding of this study demostrate that both patients and physical therapist had mostly positive experience using Skype as a service delivery model for physical therapist-supervised exercise management of moderate knee osteoarthritis (OA).

• Patients and therapists found skype consultations for knee OA to be efficient, effective, empowering, and surprisingly personal.