Physical Therapy is as Good as Surgery for Common Knee Problems
May 5, 2013 by Robert Wascher
Filed under A Cancer Prevention Guide for the Human Race, Arthritis, Arthroscopic Surgery, Knee Joint, Meniscal Tears, Meniscus, Osteoarthritis, Physical Therapy, Weekly Health Update, aging, health, physical activity
A new study finds that physical therapy may be just as effective as surgery for common knee ailments.
PHYSICAL THERAPY IS AS GOOD AS SURGERY FOR COMMON KNEE PROBLEMS
The knee joint is, perhaps, the most susceptible joint to injury in the human body. This joint is composed of an intricate combination of ligaments, cartilage and bone, and injury to any of these structures can cause pain and decreased mobility within the knee joint. Our knee joints also must bear almost the entire weight of our bodies, and so degenerative changes within this joint are very common as well. Osteoarthritis, meniscal tears, and ligamentous tears are common causes of knee pain and decreased joint mobility, and arthroscopic surgery is very commonly recommended for these knee joint ailments.
The meniscus is a cartilaginous structure within the knee joint that serves to cushion the knee joint, and to distribute the body’s weight evenly within the joint. When the cartilage that makes up the meniscus becomes worn or torn, knee pain, joint swelling, and “clicking” or “locking” of the knee joint can occur, and arthroscopic surgery is frequently performed in such cases.
A newly published prospective randomized clinical research study compares patient outcomes following arthroscopic surgery versus physical therapy, and the results of this study are likely to be surprising to many orthopedic surgeons. This clinical study appears in the current issue of the New England Journal of Medicine.
In this prospectively conducted study, 351 volunteers with meniscal tears and osteoarthritis of the knee joint were randomized to one of two groups. The first group underwent arthroscopic surgery, followed by standard postoperative physical therapy. The second group of study volunteers underwent physical therapy alone. All patients were evaluated at 6 and 12 months after they entered into this clinical study.
At both 6 months and 12 months after entry into this clinical study, there was no significant difference in knee joint symptoms between the two study groups. The findings of this important clinical study suggest that most patients with mensical tears and osteoarthritis of the knee joint tend to do as well with physical therapy alone when compared to patients who undergo arthroscopic surgery followed by physical therapy. There is one caveat to the findings of this study, however, and that is the fact that 30 percent of the patient who were randomized to receive only physical therapy in this clinical study ultimately went on to undergo arthroscopic surgery, which suggests that not all patients with meniscal tears and osteoarthritis of the knee joint will be able to avoid surgery. However, the great majority of patients in this clinical study fared equally well with surgery and postoperative physical therapy or with physical therapy alone.
Based upon the findings of this clinical research study, it would seem reasonable for most patients with meniscal injuries and osteoarthritis of the knee joint to first try a trial of physical therapy prior to considering arthroscopic surgery,
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Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author
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