Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial.
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 euro901 per patient (p < 0.001).


CONCLUSIONS
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.


BACKGROUND
Current Controlled Trials ISRCTN 41800323.
Kettunen
Jyrki A
JA
The ORTON Research Institute, Invalid Foundation, Tenholantie 10, FIN-00280 Helsinki, Finland. jyrki.kettunen@invalidisaatio.fi
Harilainen
Arsi
A
Sandelin
Jerker
J
Schlenzka
Dietrich
D
Hietaniemi
Kalevi
K
Seitsalo
Seppo
S
Malmivaara
Antti
A
Kujala
Urho M
UM
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000191:economics / Q000379:methods*; D016022:Case-Control Studies; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D046788:Patellofemoral Pain Syndrome / Q000191:economics / Q000628:therapy*; D026741:Physical Therapy Modalities / Q000191:economics; D016896:Treatment Outcome