Research Article – Superior Physical Therapy

Research Article

July 1, 2019
  • In countries with data available, knee arthroscopy is the most common orthopedic procedure
  • Data reviewed by an international multidisciplinary panel that included physical therapists
  • Guideline makes a “strong recommendation” against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; authors write that “further research is unlikely to alter this recommendation”
  • Authors write that “health care administrators and funders may use the number of arthroscopies performed in patients with degenerative knee disease as an indicator of quality care”

For patients with knee pain, the small, short-term gains in pain and function from arthroscopy are greatly outweighed by the “burden, postoperative limitations, and rare serious adverse effects” associated with the surgery, write authors of a new clinical practice guideline. Instead, authors “strongly recommend” conservative treatment over arthroscopy for “nearly all” patients with degenerative knee disease.

The guideline, published online May 10, 2017, in BMJ, is based on a 2016 systematic review that indicated outcomes for knee arthroscopy were no better than those for exercise in people with degenerative medial meniscus tear. The multidisciplinary, international panel included physical therapists, orthopedic surgeons, a rheumatologist, a general practitioner, general internists, epidemiologists, methodologists, and patients.

Authors defined degenerative knee disease as knee pain not caused by traumatic injury in patients over age 35, “with or without” imaging evidence of osteoarthritis, meniscal tears, mechanical symptoms, or “acute or subacute onset of symptoms.”

The panel considered 3 patient outcomes in their analysis: pain, function, and quality of life. Authors write, “Arthroscopic knee surgery does not, on average, result in an improvement in long-term pain or function.” Future evidence, they say, is unlikely to change this conclusion.

While the panelists did not explicitly recommend any particular type of conservative management of degenerative knee disease, they suggested that nonuse of knee arthroscopy could be used “as a performance measure or tied to health funding.”

Authors conclude, “Given that there is evidence of harm and no evidence of important lasting benefit in any subgroup, the panel believes that the burden of proof rests with those who suggest benefit for any other particular subgroup before arthroscopic surgery is routinely performed in any subgroup of patients.”

Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association’s PTNow website.


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The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. The purpose of this website is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Superior Physical Therapy does not recommend or endorse any specific tests, physicians, products, procedures, opinions or other information that may be mentioned on this website. Reliance on any information appearing on this website is solely at your own risk.

July 1, 2019

The US Centers for Disease Control and Prevention’s (CDC’s) latest snapshot of arthritis prevalence, severity, and related physical inactivity reported in 2017 looks a lot like its previous one, based on 2015 data. As then, an estimated 1 in 4 US adults have the condition, almost 27% of whom experience severe joint pain. Making matters worse, says CDC, of those with arthritis, around a third report that they don’t engage in any physical activity, the very thing that “can improve physical functioning in adults with joint conditions.”

Read More Through This Link


DISCLAIMER: THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE

The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. The purpose of this website is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Superior Physical Therapy does not recommend or endorse any specific tests, physicians, products, procedures, opinions or other information that may be mentioned on this website. Reliance on any information appearing on this website is solely at your own risk.

March 18, 2019

Should patients experiencing chronic, atraumatic shoulder pain for three or more months undergo surgery?

A new paper recently published in the BMJ advises strongly against it. The paper’s authors summarized their evidence-based recommendations into a new Clinical Practice Guideline (CPG), which can help healthcare providers and their patients make more well-informed decisions regarding their course of care.

New CPG for atraumatic shoulder pain: choose exercise, physical therapy, occupational therapy over surgery

This new CPG specifically applies to two types of shoulder pain, described as “subacromial pain syndrome” and “rotator cuff disease.” Historically, surgeons performed arthroscopic decompression surgery as an invasive approach to symptom management.

But after a thorough review of two systematic reviews featuring over 1,000 patients, the authors discovered two key findings:

  • First, decompression surgery is no more effective for relieving atraumatic shoulder pain than other treatment options—including physical therapy, analgesics, and shoulder injections. For instance, follow ups as far as two and five years out saw no significant difference in pain (as measured on the visual analog scale). The same goes for function when comparing arthroscopic surgery to other approaches.
  • Second, the researchers expanded their review to include observational studies evaluating post-operative harm, since “potential harms from surgery were incompletely reported” in the previous trials.  They found that the risks for complications—including bleeding, infections, peripheral nerve injury, anesthetic complications, and venous thromboembolism—was approximately 0.55% after 30 days post-op.

Read More Through This Link


DISCLAIMER: THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE

The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. The purpose of this website is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Superior Physical Therapy does not recommend or endorse any specific tests, physicians, products, procedures, opinions or other information that may be mentioned on this website. Reliance on any information appearing on this website is solely at your own risk.

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