Dealing with chronic knee pain
Last summer, I recall perusing through the CBC’s online headlines as I do most days and one caught my eye. Most often its sports, weather or some sensational news story that I get drawn towards but this time a health-related topic grabbed me… my ‘physio-brain’ was intrigued…
This article was titled: “Arthroscopic knee surgery: Why it may not help you” and it features a discussion with an Orthopedic Surgery Resident, Dr. Moin Khan, at McMaster University (1). In the article Dr. Khan questions the efficacy and benefit of arthroscopic meniscal debridement surgeries of the knee for patients with mild or minimal arthritis. He references a systematic review he, along with other researchers and surgeons, published in the Canadian Medical Association Journal ‘s (CMAJ) October 2014 issue as support of his position.
An arthroscopic meniscal debridement surgery is a small day-surgery that is performed to ‘clean up’ tearing in the meniscus of the knee. The meniscus is a small structure in the knee that is vital to the health of the knee joint. It serves to aid with shock-absorption, joint alignment, and even stability at the knee joint (2). A picture of the structure can be seen here:
As we age, wear-and-tear can cause degenerative changes to our joints, especially our knees, which in turn can cause mild arthritic changes to the joint and small-moderate sized tears to the meniscus (2). The meniscus is not a structure that has a great deal of pain-sensation so when we have knee pain as we age, we cannot just assume that our pain is because we have a ‘tear to our meniscus’ (3).
This is what Dr. Khan points out in his paper: that just because there may be medical imaging that suggests there is a meniscal tear, this doesn’t mean pain is the result. He states “abnormalities in anatomy and on MRI are not always correlated with symptoms” (3). For a long time, these surgeries have been done to fix a problem that may or may not be causing pain. Dr. Khan’s review concluded that there was no significant difference to patient complaints of pain and reports of quality of life at
It is for this reason this article caught my ‘physio-brain’ attention: in my experience, many of these patients will see their Family Physician and then head straight to an Orthopedic Surgeon - in essence foregoing any conservative treatment.
There are other recently published studies that support Dr. Khan’s suggestion to try physiotherapy for this condition. Both The New England Journal of Medicine and The Journal of Knee Surgery, Sports Traumatology and Arthroscopy have published literature suggesting physiotherapy is often equal to, or more helpful than surgery (4, 5).
At Movement Solutions, we see patients with both knee pain that is secondary to a degenerative meniscal tear, or with pain that is unrelated to their tear. Regardless of the situation, we ensure to take the time to properly assess a patient’s knee, determine what is providing pain, and treat accordingly. In the presence of knee pain and limitation due to a meniscal tear, we have very good success employing manual therapy and stretching to decrease pain and increase range of motion. Also, with specific strengthening and balance exercise to help stabilize the knee joint, these patients certainly note improved day-to-day function!
To conclude, I hope that Dr. Khan’s review and the CBC’s dissemination of it’s findings aid in the effort to educate most patients living with chronic knee pain to see their local physiotherapist before signing up for surgery. If you have any questions or comments about this feel free to leave them below!
- Arthroscopic knee surgery: Why it may not help you. CBC News: Hamilton. August 26, 2014. http://www.cbc.ca/news/canada/hamilton/news/arthroscopic-knee-surgery-why-it-may-not-help-you-1.2744383. Accessed March 4, 2015.
- The Knee. Theory Manual Part II: Articular Anatomy and Pathology. CPA Orthopedic Division.
- Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ. 2014; 186: 1057-1064.
- Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. N Engl J Med. 2013; 386: 1675-1684.
- Herrlin S, Hållander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surgery, Sports Traumatology, Arthroscopy. 2007; 15: 393-401.
- Picture linked from: Meniscus Tear: Katella Chiropractor and Laser Center. http://www.chiropractorinorange.com/index.php?p=281173. Accessed March 4, 2015.