Surgery doesn't relieve knee-cap pain

By Amy Norton

NEW YORK (Reuters Health) - People who suffer chronic knee pain known as patellofemoral pain syndrome are unlikely to get any more benefits from surgery than from home-based exercises, a new study suggests.

Patellofemoral pain syndrome, involves chronic pain in or around the knee cap, also called the patella. When conservative treatments like rest, ice and exercise therapy fail, doctors may try arthroscopy.

Arthroscopy is a minimally invasive procedure that allows surgeons to examine the interior of the joint through a thin scope inserted through a small incision. If there is damage in the knee -- such as inflamed tissue or torn cartilage -- the surgeon attempts to repair it.

However, in the new study, Finnish researchers found no evidence that arthroscopic surgery benefited patients with patellofemoral pain syndrome any more than exercise alone.

The 56 patients were randomly assigned to either undergo surgery or to perform therapeutic exercises at home.

A physical therapist taught the exercise patients a series of lower-body strengthening and stretching exercises that they then performed at home every day, for about 30 minutes per day. Arthroscopy patients performed the same exercises for post-surgery rehabilitation.

Nine months later, both groups showed "marked improvement" in knee pain and mobility, but there was no significant difference between the groups, the researchers report in the online journal BMC Medicine.

The one difference was in healthcare costs and time off work, according to lead investigator Dr. Jyrki A. Kettunen of the ORTON Research Institute in Helsinki. Surgery patients took an average of nine days of sick leave, versus about one day in the exercise group.

The results suggest that, at least for adults like those in the study, surgery is unlikely to bring benefits beyond those of exercise, Kettunen told Reuters Health. All of the patients were non-athletes and younger than 40.

It's not known if the results might be different for older people or athletes, the researchers note.

It's not clear what should be done if the knee pain fails to improve with exercise therapy. According to Kettunen, other treatments, such as knee braces and anti-inflammatory medication, have been tried, but there is a lack of evidence on their effectiveness.

One thing all people with patellofemoral pain syndrome can do is try to modify any activity that tends to worsen their pain, the researcher noted.

SOURCE: BMC Medicine, online December 12, 2007.