Surgery Vs Conservative Treatment for Knee Pain?

Approximately 25% of people over 45 years old, experience knee pain and other symptoms that may be severe and negatively impact quality of life. However, the best treatment of persistent degenerative knee pain and disease remains uncertain. So, do you opt for surgery or take the more conservative path? Patients and their healthcare providers must weigh up the benefits compared to the burden of having the surgical procedure.

In the western world, as many as 300 in 100 000 people undergo arthroscopic partial meniscectomy annually. In these patients, most meniscal tears are degenerative and might be regarded as the first sign of osteoarthritis. Surgery results in brief increase in pain and inevitability a restriction in activities for a period of 2–12 weeks. Current guidelines recommend against arthroscopy and/or debridement for patients with symptomatic knee osteoarthritis. However, many orthopaedic surgeons suggest that patients with mechanical symptoms such as locking or catching of the knee may benefit from arthroscopic partial meniscectomy.

A systematic review by Brignardello-Petersen and Guyatt provides high-quality evidence that patients with degenerative knee disease who undergo arthroscopy experience very small benefits in pain, function and quality of life over periods of up to 3 months when compared with patients who receive a conservative management strategy. According to the authors the small effect is of short duration and non-existent one year after surgery. The authors went on to discuss short-term and long-term follow-up studies have shown that exercise treatment improves function and activity level in patients with degenerative meniscal tears.

Supervised exercise rehabilitation has been shown to have positive effects over arthroscopic partial meniscectomy in improving quadricep muscular strength. Researchers observed that participants who had greater quadriceps strength had less cartilage loss within the patellofemoral joint, which is frequently affected by osteoarthritis.

The authors went on to encourage health care professionals looking after middle-aged patients with osteoarthritis and meniscal tears that exercises treatment should be considered versus electing for surgical intervention first. With regards to middle-aged people with persistent knee symptoms, it would appear that conservative exercise therapy is an ideal choice, certainly as the initial treatment pathway.

A tailored exercise programme assists in keeping the joints mobile and maintaining strength around the affected joints to offer support. Absolute Balance offer targeted exercise programmes such as Arthritis Army, specifically designed for the management of all forms of arthritis. If you are interested in seeking more information, please contact the Accredited Exercise Physiologists at Absolute Balance via info@absolutebalance.com.au.

 

 

Victoria Bago

Accredited Exercise Physiologist (AEP) (ESSAM)

B.Sc-ExSportsSc, GraddipSc – ExRehab, GraddipEd-Sec

 

Reference

Brignardello-Petersen R, et al. (2017). Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open

 

Stronger Leg Muscles Can Protect Against Knee Osteoarthritis (2006) Mayo Clinic – American College of Rheumatology

 

Kise, N. Risberg A. Stensrud, S. Ranstam, J. Engebretsen, L. Roos, E. (2016) Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ open