Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018

Logerstedt, David; Scalzitti, David A.; Bennell, Kim L; Hinman, Rana S; Silvers-Granelli, Holly; Ebert, Jay R.; Hambly, Karen; Carey, James L.; Snyder‐Mackler, Lynn; Axe, Michael J.; McDonough, Christine M.

doi:10.2519/jospt.2018.0301

Cited by 84 publications

(53 citation statements)

References 137 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The cumulated proportion of the patients with a concluding MDT classification increased to 80% in the first four sessions. This finding indicates that classification becomes clarified overtime in MDT as it does in clinical practice guidelines that recommend monitoring changes in the patient's status throughout the course of treatment [37,38]. However, the cumulated proportion increased only 10% over the following five sessions and generally plateaued after the 10th session.…”

Section: Research Questionmentioning

confidence: 89%

The most common classification in the mechanical diagnosis and therapy for patients with a primary complaint of non-acute knee pain was Spinal Derangement: a retrospective chart review

Hashimoto¹,

Hirokado²,

Takasaki

2018

Journal of Manual & Manipulative Therapy

View full text Add to dashboard Cite

Objectives: To preliminarily investigate in patients with a primary complaint of non-acute knee pain for ≥ 1 month: 1) the proportion of patients with non-acute knee pain classified by Mechanical Diagnosis and Therapy (MDT) as Spinal Derangements, 2) the number of sessions taken to identify the concluding classification, and 3) the ability of MDT classifications, demographics, and symptomatic baselines to predict pain reduction at 1-month follow-up. Methods: This study reviewed data from outpatients managed with MDT. For modeling knee pain reduction at the 1-month follow-up, 3 MDT provisional or concluding classifications (Spinal Derangement, Knee Derangement, and Non-Derangement) and the following variables were included: 1) gender, 2) symptom duration, 3) presence of low back pain (LBP), 4) the Japanese Knee Osteoarthritis Measure, 5) average pain intensity at the initial session using a 0-10 numerical rating scale, and 6) the Kellgren-Lawrence grade. Results: Data from 101 patients were extracted. The percentage of patients with the concluding classification of Spinal Derangement was 44.6%. This was greater in those patient's reporting concomitant LBP (p = .002) and without radiographic findings of knee osteoarthritis (p < .001). A concluding classification was determined by the fourth session in 80% of patients. Multiple regression modeling demonstrated that only the concluding classification significantly predicted the knee pain reduction at the 1-month follow-up. Discussion: These findings suggest the importance of careful screening assessments of the lumbar spine and the importance of detecting Derangements throughout the follow-up sessions for patients with a primary complaint of knee pain.

show abstract

Section: Research Questionmentioning

confidence: 89%

The most common classification in the mechanical diagnosis and therapy for patients with a primary complaint of non-acute knee pain was Spinal Derangement: a retrospective chart review

Hashimoto¹,

Hirokado²,

Takasaki

2018

Journal of Manual & Manipulative Therapy

View full text Add to dashboard Cite

show abstract

“…The literature search confirmed that neither the American Academy of Orthopedic Surgeons nor the American Physical Therapy Association (APTA) nor any other organization we could identify has developed clinical practice guidelines specifically for rehabilitative management of degenerative meniscal tear in the setting of knee OA [20, 21]. The current established PT guidelines address non-operative management of knee OA or degenerative meniscal tears [20, 21] without OA. In the absence of clear clinical guidelines for PT-based treatment of meniscal tear in the setting of knee OA, randomized controlled trials (RCTs) comparing the efficacy of PT alone to meniscectomy and PT were identified as the most relevant body of work.…”

Section: Discussionmentioning

confidence: 98%

“…Neuromuscular/functional weight bearing exercises were also included (Table 4). Exercises were designed to adhere to the strengthening guidelines established by the APTA and American College of Sports Medicine (ACSM) [21, 34]. Additionally, the literature and general practice standards lean toward progressive non-weight-bearing and weight-bearing strengthening, neuromuscular training, and weight-bearing functional exercises including unilateral stance activities to improve knee stability.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program

Safran‐Norton

Sullivan

Irrgang

et al. 2019

BMC Musculoskelet Disord

Self Cite

View full text Add to dashboard Cite

BackgroundKnee osteoarthritis (OA) is prevalent and often associated with meniscal tear. Physical therapy (PT) and exercise regimens are often used to treat OA or meniscal tear, but, to date, few programs have been designed specifically for conservative treatment of meniscal tear with concomitant knee OA. Clinical care and research would be enhanced by a standardized, evidence–based, conservative treatment program and the ability to study the effects of the contextual factors associated with interventions for patients with painful, degenerative meniscal tears in the setting of OA. This paper describes the process of developing both a PT intervention and a home exercise program for a randomized controlled clinical trial that will compare the effectiveness of these interventions for patients with knee pain, meniscal tear and concomitant OA.MethodsThis paper describes the process utilized by an interdisciplinary team of physical therapists, physicians, and researchers to develop and refine a standardized in-clinic PT intervention, and a standardized home exercise program to be carried out without PT supervision. The process was guided in part by Medical Research Council guidance on intervention development.ResultsThe investigators achieved agreement on an in-clinic PT intervention that included manual therapy, stretching, strengthening, and neuromuscular functional training addressing major impairments in range of motion, musculotendinous length, muscle strength and neuromotor control in the major muscle groups associated with improving knee function. The investigators additionally achieved agreement on a progressive, protocol-based home exercise program (HEP) that addressed the same major muscle groups. The HEP was designed to allow patients to perform and progress the exercises without PT supervision, utilizing minimal equipment and a variety of methods for instruction.DiscussionThis multi-faceted in-clinic PT program and standardized HEP provide templates for in-clinic and home-based care for patients with symptomatic degenerative meniscal tear and concomitant OA. These interventions will be tested as part of the Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial.Trial registrationThe TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 on February 14, 2017. TeMPO was also approved by the Institutional Review Board at Partners HealthCare/Brigham and Women’s Hospital.

show abstract

“…This was based on the standards of care for treating pain. [39][40][41] Ultimately if the patient outcome did not improve, that patient underwent a surgical arthroscopic procedure.…”

Section: Limitationsmentioning

confidence: 99%

Cost-Effectiveness Analysis of Needle Arthroscopy Versus Magnetic Resonance Imaging in the Diagnosis and Treatment of Meniscal Tears of the Knee

Amin

McIntyre

Carter

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

To determine whether needle arthroscopy (NA) compared with magnetic resonance imaging (MRI) in the diagnosis and treatment of meniscal tears is cost-effective when evaluated over a 2-year period via patient-reported outcomes. The hypothesis is that improved diagnostic accuracy with NA would lead to less costly care and similar outcomes. Methods: A Markov model/decision tree analysis was performed using TreeAge Pro 2017 software. Patients were evaluated for degenerative and traumatic damage to the lateral/medial meniscus. Assumed sensitivities and specificities were derived from the medical literature. The direct costs for care were derived from the 2017 Medicare fee schedule and from private payer reimbursement rates. Costs for care included procedures performed for false-positive findings and for care for false-negative findings. Effectiveness was examined using the global knee injury and osteoarthritis outcome score (KOOS). Patients were evaluated over 2 years for costs and outcomes, including complications. Dominance and incremental cost-effectiveness were evaluated, and 1-to 2-way sensitivity analysis was performed to determine those variables that had the greatest effect. The consolidated economics evaluation and reporting standards checklist for reporting economic evaluations was used. Results: NA was less costly and had similar KOOS versus MRI for both the medial/lateral meniscus with private pay.

show abstract

Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018

Cited by 84 publications

References 137 publications

The most common classification in the mechanical diagnosis and therapy for patients with a primary complaint of non-acute knee pain was Spinal Derangement: a retrospective chart review

The most common classification in the mechanical diagnosis and therapy for patients with a primary complaint of non-acute knee pain was Spinal Derangement: a retrospective chart review

A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program

Cost-Effectiveness Analysis of Needle Arthroscopy Versus Magnetic Resonance Imaging in the Diagnosis and Treatment of Meniscal Tears of the Knee

Contact Info

Product

Resources

About