Knee arthroscopies and “clean outs” are frequently performed on knees with cartilage damage, meniscal tears and osteoarthritis. But what is the evidence for it?
The first quality controlled trial was done in 2002 and showed that arthroscopies were no better than placebo and in some cases were worse. Since then the procedure is still just as common even though further studies have been completed all showing the same thing, that it is not effective in wear and tear situations. There are still situations where an arthroscopy may be necessary such as large meniscal tears that are locking the knee joint, but a good rehabilitation program is necessary post-op.
So, what else works? Exercise therapy is effective to increase strength, reduce pain and increase function in anterior knee pain, knee osteoarthritis and patellofemoral pain. In osteoarthritis the pain reduction from graded exercise is comparable to that provided by analgesics. Pain inhibits these supporting muscles which causes a cycle of pain and reduced function which further drives the pain mechanisms. Gradual knee and hip strengthening aims to interrupt this pain cycle without aggravation. Building strength around the knee helps to support the knee and maintain a good alignment which then reduces inflammation and pain. Hydrotherapy can be an effective adjunct to the exercise as it allows for large lower limb movements with resistance and body weight support. Speak to our staff if you need further information or want access to the references.