Over the past twenty years, the incidence of knee pain has increased approximately 65%.¹ At Oakville’s Palermo Physiotherapy and Wellness, we see this on a daily basis.

There could be any number of reasons for an increase in knee pain, ranging from:

• An aging population
•  Increasing obesity
•  An increased desire to be active into middle age

Many individuals, especially those with persistent knee pain, come to the clinic with imaging reports from Xray or MRI. Often these reports show osteophytes, meniscus tears, degeneration, or arthritis.

Taken in a vacuum, all of these terms imply a sense of permanence and quick google searches can indicate a need for surgery. For some, this is certainly a true statement.

However…

A 2012 study analyzed the MRI of 710 people with an average age of 62. The population was primarily Caucasian and split approximately evenly between men and women. 29% of participants reported knee pain in the past month. 89% had a positive finding on the MRI. 89%! Osteophytes were the most common, followed by cartilage damage.

People with knee pain were only slightly more likely to have positive findings than those without pain (90% compared to 86%).²

Despite radiographic evidence not necessarily correlating to symptoms of knee pain, surgical repairs continue to be quite common. This is in spite of further evidence questioning the value of surgical intervention.

• The New England Journal of Medicine published a paper comparing surgery with a placebo procedure (an incision made but no corrective action taken) in a group of people with degenerative meniscus tears. Both groups reported decreased pain at all time points up to one year and there was no significant difference between groups in the number of people who believed they were in the placebo group (basically, the sham procedure successfully tricked the participants).³
• The Canadian Medical Association Journal reviewed seven papers that compared surgery with conservative management including physio. When the data was pooled, those in surgical groups generally had lower pain in the short term but by 6 months to one year, there was no difference between groups.⁴
• The British Medical Journal did a similar review but reported on complications associated with surgery. While the rates were low, there were instances of deep vein thrombosis (clotting), infections, and pulmonary embolism (a life threatening blood clot in the lung).⁵

What to take from this?

The existing research seems to show that surgery is no better in the long term than therapy, and can introduce unnecessary risks. Additionally, new evidence implies that the positive impact of surgery might have as much to do with a psychological benefit as a mechanical one.

Admittedly, this conclusion applies to only a segment of the population with knee pain.

There are certainly individuals more likely to need and benefit from surgery including:

• Young people
• Those with a traumatic mechanism of injury
• People with advanced osteoarthritis that might require a total joint replacement.

Outside of this, clinical examination and scientific research have not done a terrific job at identifying those people with degenerative issues that do require surgery.

So what?

A program of Physical Therapy emphasizing strengthening is an appropriate way to manage persistent knee pain in middle aged and older adults who lack a traumatic mechanism. Rushing to surgery introduces the potential for medical complications and does not help more than conservative management.

Our Physiotherapists at Oakville’s Palermo Physiotherapy and Wellness Centre are happy to set you up with a program geared specifically to you to help strengthen the muscles around the knee joint and hips.

 

• Nguyen U et al. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. 2011:155(11);725-732
• Guermazi et al. Prevalance of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study. BMJ. 2012:345; e5339
• Joukainen A et al. Arthroscopic partial meniscectomy and sham surgery similar for degenerative meniscal tear. N Engl J Med. 2013:369(26):2515-24
• Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ. 2014:186(14);1057-1064
• Thorlund et al. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ:350; :h2747