Things to Consider Before Having Knee Surgery

Things to Consider Before Having Knee Surgery Blog


Knee pain is so uncomfortable and debilitating that it is easy to believe that nothing short of surgery can rectify it. The pain itself is a deterrent to any type of physical activity, and fear of doing further damage makes exercise seem like a fool’s errand. But surgery has its own pitfalls, and holds no guarantee of knee pain relief.

The Case for Conservative Care

The marvels of modern medicine offer ever improving knee replacement parts made of plastic and metal, and many recipients experience improved quality of life after a reconstructive procedure. The problem is that knee replacement does not always guarantee pain relief, and in some cases, the patient is left with greater pain and disability than before the surgery.

Most people assume that knee joint pain is a mechanical problem, like a part wearing out on your car, so it follows that a mechanic, or in this case a surgeon, can replace the defective parts and make things good as new. However, just as with your car, wear and tear on your joints stems from misalignments and motor deficiencies throughout your body, and unless you address those issues, you will continue to place stress on your knee joint.

As the demand for knee reconstructive surgery continues to grow, evidence is mounting to support conservative physical therapy treatment as the best option for providing knee pain relief.

Knee Pain Causes

In younger people, knee pain is often the result of acute trauma or repetitive overuse during sports or exercise. However, the majority of knee reconstructive surgeries are performed on older, non-athletic patients. Knee pain can stem from multiple causes, and there is often more than one factor at play.

Common causes of knee pain in non-athletic patients include:

  • Osteoarthritis, usually in older adults with severe loss of cartilage
  • Meniscus tears, often seen in middle aged and older adults
  • Overweight or obesity
  • Lack of physical activity, sedentary lifestyle
  • Muscle imbalances
  • Weak core musculature, pelvic instability

Many of the underlying causes of knee pain can be resolved with conservative, non-invasive therapy designed to correct motor deficiencies and muscle imbalances.

What Research Tells Us

A number of studies have been conducted comparing reconstructive surgery with conservative care, which encompasses patient education, physical therapy exercise, and nutritional guidance for overweight patients. Breaking the studies down into patient age groups, we find compelling results.

Young Adults: ACL tears in young athletes are common, and surgery is often a first choice line of treatment for athletes eager to return to play. But a study comparing the results of one group having extensive exercise therapy to another group who had both exercise therapy and ACL reconstruction found no differences in improvement between the two groups, and only four out of ten athletes in both groups returned to sport.

Middle Aged Adults: Many studies have been done on knee pain in middle aged patients. In two studies, outcomes of actual knee surgery were compared with sham surgery, where an incision was made but nothing was done. Outcomes were identical for both groups.

Another study compared exercise therapy alone to surgery alone in middle aged patients. Reports of pain relief were the same for both groups. However, the exercise group increased muscle tone and improved health, and was more physically active two years later, while the surgery-only group became weaker after the surgery, and took more than a year to regain pre-surgery strength levels.

Older Adults: A single study on a group of overweight older adults with knee osteoarthritis and severe loss of cartilage found knee reconstruction combined with conservative care to provide greater pain relief than conservative care alone. The tradeoff, however was that one in ten had an adverse effect from the surgery, such as a blood clot or infection, and some suffered long-term disability after surgery.

Deciding on Knee Pain Treatment

Before deciding to have surgery to relieve knee pain, talk to your knee doctor about all available options. Even if you are leaning toward surgery, pre-hab therapy can get you in the best shape possible, to improve your odds of successful recovery.

Bear in mind that surgery is an expensive and invasive option that does not guarantee results. Moreover, your surgeon will send you to physical therapy after the procedure to rehabilitate your reconstructed knee, and you will still be expected to exercise.

Conservative treatment as a first choice can save you money and improve your overall health. Contact the knee pain specialists at NYDNR today, and see why we are the best physical therapy clinic for knee pain treatment in NYC.

130 West 42 Street Suite 1055, New York NY 10036
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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