Major Medical Journal Strongly recommends against knee scope for degenerative knees

by | May 23, 2017

Most of us know someone who has had their knee scoped (also called arthroscopy) to “clean up” arthritis or a meniscal tear. Often, patients are told that the scope will delay or even prevent the need for a later knee replacement because the scope will reduce mechanical friction/rubbing in the knee. This seems fairly logical, however, research is now showing that this is not the case. Last week, one of the world’s leading medical journals, the British Medical Journal (BMJ) published guidelines making strong recommendations against knee scopes for degenerative knee disease. This review of available quality studies (systematic reviews) found that when compared to conservative care, knee scopes:

 

  • Lead to increased odds of joint replacement!
  • Offer no significant pain reduction in either the short (3-month) or long (2-year) term.
  • Offer no improvement in function in either the short (3-month) or long (2-year) term.
  • Offer no improvement in quality of life in either the short (3-month) or long (2-year) term.

You can read the full guidelines and appraisal of the literature in clear English here: http://www.bmj.com/content/357/bmj.j1982

 

Typical scars from a knee scope

Typical scars from a knee scope – are they worth it?!

As you can imagine, these findings are causing a lot of controversy in the orthopedic world! Knee scopes have been used for many years, with both patients and surgeons reporting good satisfaction rates. You may have experienced it yourself – knee pain that did not improve until you had a knee scope. So how can this research be showing that it doesn’t help?!

We need to keep in mind that research focuses on statistics and large groups of people as a whole; it cannot tell us that a knee scope wasn’t helpful for an individual person. If you experienced relief from a scope, I am certainly not going to tell you that the relief you’ve experienced isn’t real! We also have to keep in mind that the body isn’t a mechanical machine like a car; it is far more complex and dynamic, and there are almost certainly factors affecting the success of the various conservative treatments you might have tried prior to a scope that we don’t completely understand. For example, you might have received treatments that we now know don’t help with arthritis (such as ultrasound), or perhaps the PT exercises you were prescribed weren’t challenging enough to aid healing (another rapidly evolving area of research).

 

So, what should you do if you have knee pain or have been diagnosed with arthritis or a degenerative meniscal tear, and are considering a knee scope? Even if you are already considering surgery, this research can absolutely help you maximize the odds that you find permanent relief and avoid a total knee replacement for as long as possible. Before you go for the knee scope, I would recommend giving physical therapy a trial first, specifically, PT that uses a graded exercise approach. In other words, the PT will prescribe you a set of exercises to perform over a few weeks and will progress the difficulty of the exercises as you strengthen – typically every 1-2 weeks. This is a bit different than the common 2-3 times a week for 4-6 weeks PT schedule that is common; PT visits this frequently typically build in many other passive treatments alongside the exercise. But research shows that passive treatments like ultrasound don’t help arthritis. A longer-term approach to exercise will strengthen and rebuild the muscles, tendons, and other knee structures, while also changing how the brain perceives pain. If you consider how long it took for the knee to degenerate into the state it’s currently in,  it makes sense to also give it longer than 4-6 weeks to improve before resorting to surgery. Runners might want to continue running, and non-runners might want to consider slowly taking it up as there is good research suggesting running might slow down or even reverse arthritic changes (see our recent blog!).

 

My aim in sharing this is not to criticize orthopedists – I am thankful to know some great orthopedic surgeons because sometimes surgery is absolutely the right answer! Nor would I say that physical therapy is always the right treatment. But I do want my clients and readers to be able to make decisions that are well-informed, and to find healing with the safest, most conservative treatment that is effective for them! What that looks like will be a little bit different for each person.

 

If you are reading this and have further questions, send me a message or comment below. You might also want to sign up for our newsletter where we will publish blogs, offers and other updates in the sports medicine and orthopedic world.
 Do you know anyone suffering from degenerative knee pain? Share this post with them!

 

Regards,

 

Andrew Walker, PT

 

[gravityform id=”2″ title=”false” description=”false”]
Image Source:
Photo credit: Tim Evanson via Foter.com / CC BY-SA
Tendon Compression an important thing to consider for some tendons

Tendon Compression – Important to Consider For Some Tendons!

Not all tendons and tendon pain should be treated the same. For example, we tend to consider Achilles tendon pain ...
Read More

What Is The Right Running Shoe For Me?!

Modern advances (and claims) have not done much for injury risk! Runners assign a huge level of importance to footwear ...
Read More
Carpal tunnel and neck pain care in huntsville and madison alabama

When is Carpal Tunnel Not Carpal Tunnel

There is often the assumption that numbness in the hand is due to carpal tunnel syndrome. However, oftentimes these symptoms ...
Read More
Huntsville Madison runners need strong soleus muscles to help avoid achilles problems

Why You Need a Strong Soleus!

Why You Need a Strong Soleus! The soleus is a big calf muscle, but oftentimes is unloved! It is actually ...
Read More
interview with a fitness professional in Huntsville and Madison with Joe Martin of Huntsville Adventure Boot Camp

Interview With Joe Martin of Huntsville Adventure Boot Camp

The Huntsville/Madison Health and Fitness Professionals I Trust #2 As a physical therapist it is often important to refer my ...
Read More
Evidence based treatment huntsville and madison alabama

Trick or Treat!

Trick or Treat - Is The Treatment To Good To Be True? When healthcare professionals recommend a treatment, it should ...
Read More
Loading...

0 Comments

Submit a Comment

Your email address will not be published. Required fields are marked *

google logoPhysioWorks, Sports and Wellness, Inc.PhysioWorks, Sports and Wellness, Inc.
5 Stars - Based on 44 User Reviews

facebook logoPhysioWorks, Sports and Wellness, Inc.PhysioWorks, Sports and Wellness, Inc.
5 Stars - Based on 22 User Reviews

Never miss a blog!

Andrew is amazingly gifted. He has helped me with various issues stemming from a life-long issue. I am now much better off than I have been in years and continue to work to strengthen myself under his care. We have recommended several friends and all have been thrilled. My family feels very fortunate to be able to work with Andrew and experience an improved quality of life. Consider your research over. Make an appointment, you will not regret it!

Matt Willauer Avatar Matt Willauer
9/17/2018

I have been working with Andrew for a few months and have had a lot of relief from lower back pain due to a powerlifting injury. He is very professional and patient to explain everything I had questions about. I highly recommend PhysioWorks to anyone seeking a solution to their needs. With Andrew's help I have managed to avoid back surgery and gained confidence to get back in the weight room and lift properly and safely!

Melissa Astin Avatar Melissa Astin
4/29/2019

Andrew is super great! He keeps up with the latest research and uses it to better treat his patients. I came to him because I was having knee pain that kept me from running like I wanted to. He did a running analysis and identified some problem points. With the exercises her prescribed, I was able to get back to running (and was stronger), and I even completed a half marathon only a couple months after starting PT. Unlike traditional PT, I only had to go a few times over a couple months as opposed to several times per week,... read more

Melissa Wilk Avatar Melissa Wilk
4/09/2019