Knee arthroscopy vs. exercise program in chronic patellofemoral pain syndrome

2007/12/18

A controlled study by Finnish researchers from the ORTON Research Institute / University of Helsinki (Finland) showed that in patients with chronic patellofemoral pain syndrome the outcome of arthroscopy combined with a home exercise program was not better than the use of a home exercise program alone.

Patients with chronic patellofemoral pain syndrome (PFPS) are often treated with arthroscopy, however, there is a lack of evidence regarding efficacy of arthroscopy. Therefore J.A. Kettunen and colleagues performed a randomized controlled clinical trial using both treatments in PFPS patients.

A total of 56 patients with chronic PFPS were assigned to one of two treatment groups (n=28 patients each): an arthroscopy group treated with knee arthroscopy and an 8-week home exercise program (HEP), and a control group treated with 8-week HEP alone. During arthroscopy, specific surgical procedures were done on the knee joint according to current recommendations.

At 9 months following randomization as well as after second follow-up at 24 months, the Kujala score on patellofemoral pain and function was assessed as primary outcome. In addition, the investigators also determined pain intensity using visual analog scales to assess activity-related symptoms, as well as direct healthcare costs.

After 9 and 24 months, both groups showed an improvement of PFPS symptoms such as reduced pain and marked improvement in knee mobility: The mean improvement in the Kujala score was 12.9 (95% CI 8.2 to 17.6) in the arthroscopy group and 11.4 (95 CI 6.9 to 15.8) in the control group. But there was no statistically significant difference in mean Kujala scores (group difference of 1.1, 95% CI -7.4 to 5.2) nor in any of the VAS scores. Total direct healthcare costs in the arthroscopy group exceeded that of the HEP group by EURO 901 (or USD 1,333.46) per patient, a statistically significant difference (p less than 0.001). The mean number of sick leave days was 8.7 in the arthroscopy group and 1.4 in the control group (p less than 0.001).

In summary, the authors suggest that a home exercise program in PFPS patients not only has a better therapeutic outcome than the combination with arthroscopy, but also that giving these patients a therapeutic exercise regime rather than using arthroscopy could save money.

Kettunen JA, Harilainen A, Sandelin J, et al. Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain. BMC Med 2007;5:38