UNNECESSARY

SURGERY WITH A KNEE EXAM PT Helps Meniscus Pain

“We determine what’s different between the legs and how we can make them the same,” says Dr. Shelbourne.

Continuity and Consistency

A physical therapist is always part of the initial patient visit at Shelbourne Knee Center. This ensures continuity and consistency in treatment. By being in the room with the orthopedic surgeon, the physical therapist hears the patient’s story and the discussion with the surgeon.

“The patient doesn’t have to tell the story twice and the physical therapist gets the same story as the orthopedic surgeon,” says Laura Bray-Prescott, PT/LATC, Rehab Supervisor at Shelbourne Knee Center. That’s important because patients often remember things as the exam proceeds with the doctor. If patients go from the doctor’s office to the PT’s office, they may not be able to recall, or possibly didn’t understand, everything the doctor told them about the knee to tell the therapist.

A 49-year-old female who had not been injured woke up with right knee pain and swelling. An orthopedic surgeon ordered X-rays, which were normal, and treated the patient with a cortisone injection. This relieved the patient’s pain for a few days. The surgeon then ordered an MRI and diagnosed a medial meniscus tear. He recommended an arthroscopy. The patient sought a second opinion at Shelbourne Knee Center, where K. Donald Shelbourne, MD, examined both knees and reviewed the MRI scan. He diagnosed an extruded medial meniscus, which doesn’t respond to surgery because it’s the result of early osteoarthritis. He recommended PT, which is improving the patient’s symptoms and restoring meniscal function.

Improving Without Surgery

The COVID-19 pandemic highlighted how often surgery is unnecessary. While nonemergency surgery at Community Hospital East was shut down, patients at Shelbourne Knee Center continued to do their

Survey to Determine Knee Examination Practices3

Shelbourne Knee Center surveyed 428 patients (average age of 42.4 + 18.7 years) with a unilateral knee problem who saw at least one other physician within six months of getting a second opinion at Shelbourne Knee Center. The patients saw orthopedic surgeons (202), primary care providers (154), chiropractors (44) and emergency physicians (28).

CASE #2

Nonsurgical Relief for Severe OA

Based on X-rays, a 66-year-old female with chronic bilateral knee pain was told she had bone-on-bone osteoarthritis (OA) and that total knee replacement (TKA) was her only option. The patient’s mother had a terrible experience with TKA, and the patient didn’t want to go through this. For seven years, she lived with pain and stiffness. When she went to Shelbourne Knee Center for a second opinion, orthopedic surgeon Rodney Benner, MD, examined her knees and recommended the Center’s research-backed Knee Rehabilitation Program for OA. Dr. Benner gave her cortisone injections in both knees to manage the pain and facilitate PT. If she later decides to have surgery, the improvement in range of motion and strength she’s achieving in the program will lead to a better outcome and a faster, easier recovery.

PT at home, with guidance from their physical therapists. When the hospital reopened about three months later, about 50% of patients who were waiting for surgery had improved enough that they no longer needed surgery, says Dr. Shelbourne.

“Physicians need to get back to the basics of the accepted standard for a thorough knee examination and talk with their patients,” says Dr. Shelbourne. MRI scans should supplement, not substitute, for a knee examination. They should be used to confirm and correlate with the findings of the physical exam and the patient’s symptoms.

References

1. Shelbourne, KD. The art of the knee exam. Presentation at Andrews University, February 10, 2022.

2. Shelbourne, KD. The Art of the Knee Examination: Where Has It Gone? The Journal of Bone & Joint Surgery. August 4, 2010 - Volume 92 - Issue 9 - p e9 doi: 10.2106/ JBJS.I.01691

3. Patient Survey on Knee Exams. Shelbourne Knee Center, 2009. Unpublished data.