Chronic knee pain: Is surgery the only solution?

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The results of a study published in the online open access journal, BMC Medicine indicate that sufferers of chronic patellofemoral syndrome (PFPS), a chronic pain in the front part of the knee, gain no extra benefit from surgery. Furthermore, the authors suggest that giving these patients a therapeutic exercise regime rather than putting them through surgery could save money.

Patellofemoral pain syndrome is often treated with arthroscopic surgery, in which equipment inserted through small incisions in the knee is used to both diagnose the cause of the problem and attempt to fix it.

Jyrki Kettunen of The ORTON Research Institute, in Helsinki, Finland, and colleagues point out that whilst chronic knee pain is a common complaint, there is a lack of evidence that arthroscopic surgery has a better outcome than other forms of treatment including therapeutic exercise.

The team conducted a randomized controlled trial to study the efficacy of arthroscopy compared with exercise in 56 patients with chronic PFPS.

The patients were randomly divided into two groups; the first group was treated with knee arthroscopy and an eight-week home exercise program and the second group was treated with the exercise program only. The researchers assessed the patients after 9 months using the Kujala score for knee pain and mobility. They also estimated the direct healthcare costs per patient.

The researchers found that patients in both groups experienced reduced pain and showed marked improvement in knee mobility, with no significant difference in the average Kujala score between the two groups. Other tests also revealed that the improvements for patients treated with surgery and exercise were almost exactly the same as for the exercise-only patients. However, the average cost of treatment was €901 ($1,333.46) higher per patient who underwent both arthroscopy and exercise therapy.

The researchers also carried out a second follow up at two years and still found no differences in outcome between the two patient groups. They concluded that arthroscopy is not a cost effective treatment for chronic PFPS and that surgery should not be routinely used to treat the condition.

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