As we discussed last week, degenerative meniscal tears and osteoarthritis (OA) are extremely common in the general population.
MRI is not recommended for the diagnosis or management of OA and meniscal tears.
But when pain, stiffness and swelling limit activities, what can be done?
Evidence (see Quick Links section for full journal articles) shows that:
- Arthroscopic surgery for OA of the knee provides no additional benefit to optimized physical and medical therapy;
- In a trial involving patients without knee OA but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.
It seems that activity is actually the best treatment for knee arthritis when benefit/risk ratio is considered.The type is not important, but supervised and more frequent activity (>3 times/week) are more advantageous.
Topical NSAIDs are effective followed by intra-articular corticosteroid injection. Dr. Raj Carmona, rheumatologist and Associate Professor of Medicine at McMaster, has an excellent website (www.rheumtutor.com), outlining various approaches to injecting the knee. Surprisingly, or not, acetaminophen, glucosamine, chondroitin and viscosupplementation have little meaningful benefit when systemic reviews of high quality studies are considered.
So maybe we are just following Voltaire’s philosophy: The art of medicine consists of amusing the patient while nature cures the disease.
For those enrolled in PBSG, you can find further in-depth information and an excellent section on knee OA in Vol 24(13) November 2016, Clinical Pearls and Best Practices for Common Problems.