Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial

Jyrki A Kettunen¹ , Arsi Harilainen² , Jerker Sandelin² , Dietrich Schlenzka² , Kalevi Hietaniemi³ , Seppo Seitsalo² , Antti Malmivaara⁴ and Urho M Kujala⁵

¹The ORTON Research Institute, Invalid Foundation, Tenholantie 10, FIN-00280 Helsinki, Finland

²The ORTON Orthopaedic Hospital, Invalid Foundation, Tenholantie 10 FIN-00280 Helsinki, Finland

³The Helsinki University Central Hospital, Jorvi Hospital, Turuntie 150, FIN-02740 Espoo, Finland

⁴The Finnish Office for Health Care Technology Assessment/National Research and Development Centre for Welfare and Health, Lintulahdenkuja 4, FIN-00530 Helsinki, Finland

⁵The Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FIN-40014 University of Jyväskylä, Finland

author email corresponding author email

BMC Medicine 2007, 5:38doi:10.1186/1741-7015-5-38


Published:	13 December 2007

Abstract

Background

Arthroscopy is often used to treat patients with chronic patellofemoral pain syndrome (PFPS). As there is a lack of evidence, we conducted a randomized controlled trial to study the efficacy of arthroscopy in patients with chronic PFPS.

Methods

A total of 56 patients with chronic PFPS were randomized into two treatment groups: an arthroscopy group (N = 28), treated with knee arthroscopy and an 8-week home exercise program, and a control group (N = 28), treated with the 8-week home exercise program only. The arthroscopy included finding-specific surgical procedures according to current recommendations. The primary outcome was the Kujala score on patellofemoral pain and function at 9 months following randomization. Secondary outcomes were visual analog scales (VASs) to assess activity-related symptoms. We also estimated the direct healthcare costs.

Results

Both groups showed marked improvement during the follow-up. The mean improvement in the Kujala score was 12.9 (95% confidence interval (CI) 8.2–17.6) in the arthroscopy group and 11.4 (95% CI 6.9–15.8) in the control group. However, there was no difference between the groups in mean improvement in the Kujala score (group difference 1.1 (95% CI -7.4 - 5.2)) or in any of the VAS scores. Total direct healthcare costs in the arthroscopy group were estimated to exceed on average those of the control group by €901 per patient (p < 0.001).

Conclusion

In this controlled trial involving patients with chronic PFPS, the outcome when arthroscopy was used in addition to a home exercise program was no better than when the home exercise program was used alone.

Trial registration

Current Controlled Trials ISRCTN 41800323