Exercise 'as effective as surgery' for knee damage

[WillBrink]

At least for this injury and this population, rehab should probably be first line treatment:

Exercise 'as effective as surgery' for knee damage

22nd July 2016 – Exercise is as effective as surgery for middle-aged patients with degenerative meniscal tears of the knee (damage to the rubbery discs that cushion the knee joint), according to a study published in the BMJ.

Dr Nina Jullum Kise, from the Department of Orthopaedic Surgery at Martina Hansens Hospital, Sandvika, Norway, and colleagues conducted a trial that included 140 adults, average age 49.5 years, with degenerative medial meniscal tear verified by MRI scans. Only 4% of the patients showed definitive radiographic evidence of osteoarthritis.

Half the patients were randomly assigned to a 12-week supervised programme (2-3 sessions each week) of progressive neuromuscular and strength exercises, and half received arthroscopic surgery followed by simple advice to perform daily exercises at home.

The researchers tested thigh muscle strength at 3 and 12 months and recorded patient-reported knee function at 2 years.

The authors found no differences at 2 years between the groups in knee function and found greater muscle strength in the exercise group at 3 months.

Those in the exercise group also reported significantly fewer symptoms such as mechanical problems, swelling and decreased range of movement.

Nineteen percent of the participants crossed over from the exercise group to the surgery group during the 2-year follow-up, with no additional benefit.

"Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option," the authors write.

http://www.webmd.boots.com/news/2016...or-knee-damage

[WS6]

This is excellent. I think if people can forgo the knife, all the better.

[sjoliat]

Going on 45 now, but went to see an orthopedist on my 41st birthday for pain in both knees. I'm a contractor and a lot of my jobs require working extensively on my knees, in addition to having been a semi-frequent runner. Figured it was time for a little arthroscopic clean-up. Was told that while there was some damage to the meniscus, the bigger problem was osteoarthritis in both knees and there was nothing they would do until it got much worse. Happy freaking birthday. He recommended strength training. Pretty glad that it wasn't just a surgical clean-up, because it was the impetus that got me back into exercising regularly. My regimen mostly is a variation of swimming, elliptical, stationary bike and rowing machine, along with various core and free weight exercises. I run still, but really just enough to be able to hang with my 9yo daughter that is running 27min 5Ks. With anti-inflammatory supplements and some occasional ibuprofen, pain is the least it's been in a decade.

[hermes200]

@willbrink, thanks for this thread. for about a yr now i have been having problem with my left knee and it does make me get a lot of sleep at night and i have been thinking of getting surgery but probably physical therapy is the solution.

[Det-Sog]

This is excellent. I think if people can forgo the knife, all the better.

Never get cut if there are viable alternatives.

[ramairthree]

Yep.
People get surgery for pain a lot.
Rarely turns out well.
Typically some combination of people that seek surgery for pain and the nature of the surgery.

People that get surgery for function,
Different story.

[Digital_Damage]

12 weeks is a long time out of action going through therapy vs the 4 weeks getting it scoped. Would be interested in the biometrics of the participants before and after.

I can see how this might be a viable option for those 45+

[Hmac]

Figured it was time for a little arthroscopic clean-up. Was told that while there was some damage to the meniscus, the bigger problem was osteoarthritis in both knees and there was nothing they would do until it got much worse.

Hmmm...osteoarthritis means bone-on-bone, which it turn means a hell of a lot more than "some damage to the meniscus". Parts of the meniscus are...gone.

I put little stock in radiographic indications of osteoarthritis. That's a clinical diagnosis. The primary radiographic indicator of osteoarthritis is spurring or other exophytic formation, which means very advanced arthritis. It take a hell of a lot less inflammation that that to cause serious knee pain.

As to exercise...yes. Quadriceps strength is absolutely key to knee stability, and if the knee is unstable then any sliding around of the joint surfaces will aggravate any bone-on-bone osteoarthritis and make it more painful. Good quadriceps exercises are very important, but it's a temporizing measure hoping to control symptoms, not actually fixing anything. The goal of all that is to put off definitive treatment for as long as possible. By definitive treatment, I mean total or partial knee replacement. That's the endpoint. The interim goal is to try to control the pain from the osteoarthritis to get to the finish line without the knee replacement and still have a meaningful life from an activity standpoint.

[Hmac]

Yep.
People get surgery for pain a lot.
Rarely turns out well.
Typically some combination of people that seek surgery for pain and the nature of the surgery.

People that get surgery for function,
Different story.

Typically, pain is what limits function. Fix pain, fix the function.