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Chronic knee pain: Is surgery the only solution?

December 12, 2007

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.
-end-
Article: Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome. A randomized controlled trial.
Jyrki A Kettunen, Arsi Harilainen, Jerker Sandelin, Dietrich Schlenzka, Seppo Seitsalo, Kalevi Hietaniemi, Antti Malmivaara and Urho M Kujala.
BMC Medicine (in press)

During the embargo, article available at: http://www.biomedcentral.com/imedia/2238633241418105_article.pdf?random=42726

After the embargo, article available at: http://www.biomedcentral.com/bmcmed/

Article citation and URL available on request at press@biomedcentral.com on the day of publication

Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central's open access policy.

BMC Medicine publishes original research articles, technical advances and study protocols in any area of medical science or clinical practice. To be appropriate for BMC Medicine, articles need to be of special importance and broad interest. BMC Medicine (ISSN 1741-7015) is indexed/tracked/covered by PubMed, MEDLINE, BIOSIS, Scopus, CAS, Google Scholar and Thomson Scientific (ISI).

BioMed Central (www.biomedcentral) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.

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