FALL 2022
NEWS
KNEE TREATMENT RESEARCH-BASED INSIGHTS THAT MAXIMIZE PATIENT OUTCOMES
K. DONALD SHELBOURNE, MD, PERFORMS A KNEE EXAM.
AVOIDING UNNECESSARY SURGERY WITH A KNEE EXAM Common knee problems such as asymptomatic meniscus tears and most osteoarthritis will heal with nonoperative treatment. Yet, patients with these problems are often told they need surgery based solely on an MRI or X-rays. When patients turn to Shelbourne Knee Center for a second opinion, they’re surprised when the orthopedic surgeon thoroughly examines both of their knees—the first step in making a definitive diagnosis and avoiding unnecessary surgery.1, 2 “Patients don’t want surgery,” says K. Donald Shelbourne, MD, an orthopedic surgeon at Shelbourne Knee Center. “They just want to get better.”
Most orthopedic surgeons who perform a knee exam only examine the involved knee, sometimes without exposing the knee. A survey of 428 patients with a unilateral knee problem who saw another physician within six months of going to Shelbourne Knee Center3 found that 37% of orthopedic surgeons touched the noninvolved knee and 63% exposed the knee for the exam. Lack of training in performing proper knee exams and increasing dependence on MRI to diagnose knee problems leads to unnecessary surgery, especially for asymptomatic meniscus tears in patients over age 40 and patients with osteoarthritis, says Dr. Shelbourne. There is also
a possibility that a symptomatic meniscus tear could calm down without surgery. In patients age 40 and older and patients who have had knee surgery, MRI results will not be normal and are often read as a meniscus tear. Physical therapy (PT) is effective for asymptomatic meniscus tears and some types of symptomatic meniscus tears that don’t respond to surgery. Nearly all patients with osteoarthritis who were told they need a total knee replacement have limited extension and flexion. “That’s a reversible problem,” says Dr. Shelbourne. “Through physical therapy, about 80% of our patients improve to the point that they don’t want surgery.”
Improving Diagnosis To evaluate knee problems, orthopedic surgeons should obtain a good subjective history and examine the involved and noninvolved knees. The history includes a discussion of: • Onset and circumstances of the knee problem • Symptoms • Previous treatments or self-care • Limitations in daily functioning. Shelbourne Knee Center gives patients shorts so that orthopedic surgeons can examine their thighs, knees and legs, looking for signs such as atrophy, swelling, tenderness and loss of extension in the involved knee. Usually, the orthopedic surgeons make the diagnosis based on the history and knee exam. Radiographs, or occasionally MRI, are sometimes used to confirm the diagnosis. CONTINUED ON NEXT PAGE
Shelbourne Knee Center
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| FixKnee.com 1 8/24/22 3:48 PM