Workers' Compensation: Knee pain

Friday, December 27, 2013

Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear

Today's post was shared by NEJM and comes from www.nejm.org

Background

Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.

Methods

We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100, with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure.

Results

In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, −1.6 points; 95% confidence interval [CI], −7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, −2.5 points; 95% CI, −9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, −0.1; 95% CI, −0.9 to 0.7). There were no...

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Thursday, December 26, 2013

You may not be better off after knee surgery

Today's post is shared from cnn.com

(CNN) -- Patients who underwent simulated knee surgery fared just as well as those who got the real deal, according to a new study that's raising eyebrows about the most common orthopedic procedure performed in the United States.

The findings, published Thursday in the New England Journal of Medicine, add to a string of papers suggesting that arthroscopic partial meniscectomy fails to help many patients. The operation typically is performed to relieve knee pain, whether from wear or from an injury.

But other doctors say it's still too soon to draw sweeping conclusions.

The study, which was conducted in Finland, followed 146 patients between the ages of 35 and 65 with symptoms of degenerative wear and tear of the meniscus, a disk-shaped piece of cartilage that acts as a shock absorber between the shinbone and thighbone. They had no detectable arthritis, suggesting that any pain was due to a problem with the meniscus.

About half the patients underwent an arthroscopic meniscectomy, in which a surgeon inserts a blade through a tiny incision in the knee, and essentially shaves down the rough, frayed edges of the meniscus.

The other half underwent an elaborately staged "sham" surgery, in which the doctor made an incision and poked around without any actual manipulation, shaving or cutting.

A year later, there was no significant difference in the knee pain reported by patients in each group. Nearly two-thirds on each side said they were happy with the results, and most said...

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