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Knee Pain

301 bytes added, 14:26, 31 May 2016
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* '''NSAIDs'''. Using NSAIDs does not generally improve healing, can mask symptoms and is a cause of cartilage damage<ref name="KneeNSAID"/>. An animal study showed that Asprin resulted in greater cartilage degeneration<ref name="KneeAsprin"/>. More at [[NSAIDs and Running]].
=Surgery=
Surgery for knee problems is a common treatment, but the research suggest is may not be worthwhile. While surgery and exercise seem to generally result in improved pain, function, and quality of life, it doesn't do better than a program of exercise. So far I've found no research supporting knee surgery, though most of the research I've found has been on degenerative meniscus tears and the subjects are not runners. However, it seems possible to me that knee surgery may help some subjects and harm others, with the net effect being no average benefit. ==Degenerative Meniscus Tears==While a meniscus tear is a common knee injury, the only research I could find on this condition concerns degenerative tears.
* A 2012 study looked at 102 patients with a meniscus tear and compared surgery with strengthening and found no difference in terms of function or pain after two years<ref name="YimSeon2013"/>. Both groups reported a high (and similar) degree of satisfaction, with two thirds reporting complete pain relief. The exercise group was given supervised training three times per week for three weeks, then a further eight weeks of unsupervised exercise, while the surgical group only had the 8 weeks of unsupervised exercise. The exercise consisted of stretching the hamstrings and quads (1 min each), 3 x 10 reps of leg extensions, leg curls, half squats and full squats, plus 15 minutes of cycling. The squats were only for the last 3 of the 8 weeks, and all exercise was to be with some strain but almost pain free. There's no reason to believe this regime is optimal, but it's an interesting starting point. The patients had a degenerative horizontal tear and the surgery removed part of the meniscus only, but there is no indicates from the study of the proportion removed. The [http://www.orthopaedicscore.com/scorepages/tegner_lysholm_knee.html Lysholm score]for the subjects was ~65 which indicates "poor" status.
* A 2013 study looked at with a meniscal tear and osteoarthritis in 351 subjects, with half randomly assigned to surgery, the others to physical therapy<ref name="KatzBrophy2013"/>. The study did not find any significant difference in functional improvement after 6 months. (30% of those assigned to physical therapy elected to have surgery before the 6 months were up. Those subjects had worse symptoms at the 2-month mark, but some of the best overall results at the end.) There were no details on the type or severity of the meniscus tear, or the percentage of meniscus removed.
* A 2008 study found that 60% of subjects aged 50+ had meniscus tears<ref name="EnglundGuermazi2008"/>. The rate of meniscus tears was similar in patients with and without knee pain symptoms. What's not clear is that if you have a meniscus tear and you have knee pain, what's the chance of the two being unrelated? It seems quite possible from the data that you could have surgery for a meniscus tear that has nothing to do with your pain.
* A 2013 study looked at 96 subjects over five years after either surgery plus 2 months of exercise or just exercise for with degenerative meniscal tears<ref name="HerrlinWange2012"/>. No difference was found in the outcomes at the 2 and 5 year marks. It's worth noting that a third of the exercise only group still had disabling knee problems after the exercise therapy but they improved to the same level as the other subjects after surgery.
* A 2013 study comparing surgery with sham surgery for degenerative meniscus tears (without osteoarthritis) in 146 subjects over 12 months found no difference between the groups<ref name="Sihvonen-2013"/>. The subjects had knee pain for more than three months prior and had not responded to conservative treatment. Both groups improved over the 12 months, but there was no difference between the groups. This is one of the highest quality studies available, with some lengths taken to blind the subjects to their knowledge of the surgery or sham surgery. There was no indication of how much meniscus was removed, though the subjects had an average Lysholm score of 60 significant problems.
* A 2007 study looked at 90 subjects with degenerative meniscal tears who were given either exercise or exercise plus surgery<ref name="Herrlin-2007"/>. Both groups reported similar improvements in pain, knee function and quality of life. The exercise consisted of cycling, calf raises, leg press, stair walking, wobble board, jumping, stretching, and similar exercises to improve strength and balance. The average Lysholm score of the subjects was 65, but the range was 24-94.
* A small 2012 study of just 17 subjects with an MRI-verified degenerative meniscus compared surgery (n=8) with exercise (n=9) over three months and found no difference in pain levels or knee function<ref name="ØsteråsØsterås2012"/>. However, the study did find that the surgery group had statistically more anxiety and depression.
* A 2014 analysis of the available research concluded that "There is moderate evidence to suggest that there is no benefit to arthroscopic meniscal débridement for degenerative meniscal tears"<ref name="Khan-2014"/>. This review looked at seven trails (all of them noted here in more detail.)
* A 2013 study compared surgery with steroid injections for degenerative meniscus tears in 114 subjects<ref name="Vermesan-2013"/>. They randomly received surgery or injections of betamethasone and lidocaine and evaluated at one month and one year. The study found only a marginal improvement in the surgery subjects over the steroid injection. However, given the evidence that surgery is no more effective than avoiding surgery, it might be better to say that steroid injections are worse than no surgery or surgery.
* There are indications that meniscus surgery may increase the risk for osteoarthritis, with the amount of meniscus removed tending to predict a higher osteoarthritis risk<ref name="PapaliaDel Buono2011"/>. However, it's also possible that a meniscus tear without surgery also increases risk for osteoarthritis <ref name="EnglundGuermazi2009"/>.
* A 2008 study found that 60% of subjects aged 50+ had meniscus tears<ref name="EnglundGuermazi2008"/>. The rate of meniscus tears was similar in patients with and without knee pain symptoms. What's not clear is that if you have a meniscus tear and you have knee pain, what's the chance of the two being unrelated? It seems quite possible from the data that you could have surgery for a meniscus tear that has nothing to do with your pain.
==Surgery for Other Knee Injuries==
* A 2010 study of 121 young adults compared two treatment approach for acute, traumatic ACL injury<ref name="FrobellRoos2010"/>. One group received rehabilitation and surgery within 10 weeks (early group), the other group received rehabilitation with an option for surgery if required (delayed group). Only 40% of the delayed group underwent surgery, and both groups had similar success in terms of pain, quality of life, and difficulty in sports/recreational activities.
* A 2008 study of arthroscopic surgery for osteoarthritis found that surgery had the same success rate as those who did not undergo surgery<ref name="KirkleyBirmingham2008"/>. The study looked at 92 surgical patients and 86 controls over 2 years, with both groups receiving 12 weeks of physical and medical therapy, including exercise. The patients were told to continue the exercise unsupervised for the rest of the study. The evaluations at 3, 6, 12, 18, and 24 months showed both groups improved a similar amount. This was a follow on to a 2002 study that had also found no difference in outcome from surgery or a placebo surgery<ref name="MoseleyO'Malley2002"/>,

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