Patients quickly return to activity after knee arthro - Academy News at the 2007 AAOS Annual Meeting

Patients quickly return to activity after knee arthroscopy

By Jennie McKee

It’s a question every orthopaedic surgeon hears: “How soon can I get back to my normal activities?” For some surgeries, the answer is well known. But until now, return to activity after knee arthroscopy has not been well documented.

According to scientific paper 430, more than half of all knee arthroscopy patients (62 percent)—athletes and non-athletes—have no knee-related activity restrictions four weeks after surgery. In addition, of 72 consecutive patients (36 male and 36 female), 82 percent returned to light activities like walking, housework or gardening just one week after surgery, and by four weeks postoperative, all patients had returned to light activities.

Knee arthroscopy is considered to be a minimally invasive surgery; patients are often told that they will recover quickly from the procedure. But arthroscopy is performed for a variety of conditions and on diverse populations. No previous study, said the presenters, evaluated whether study subjects “return to unrestricted activity,” despite return to athletic training, work or driving.

This institutional review board-approved prospective case series involved 72 patients, a single surgeon, and multiple arthroscopic knee procedures, including: partial medial meniscectomy, partial lateral meniscectomy, chondroplasty, loose body removal, and/or synovectomy. Patients having meniscus repair, lateral retinacular release, ligament reconstruction or cartilage restoration procedures, patients unwilling to complete study informed consent from or participate in follow-up, and patients with workmen’s compensation insurance claims were excluded.

Table 1  Level of activity definitions

(based on the 2000 International Knee Documentation Committee Subjective Knee Evaluation Form)

  • Very strenuous: jumping or pivoting as in basketball or soccer
  • Strenuous: heavy physical work, skiing or tennis
  • Moderate: moderate physical work, running or jogging
  • Light: walking, housework or yard work
  • Unable: unable to perform any of the above activities due to knee pain

All patients received standardized postoperative instructions that called for minimal activity on the day of surgery, knee elevation, crutch support for a maximum of two days, and specific exercises. Patients completed a preoperative diary, as well as a postoperative diary (weekly for the first month, then monthly for the first six months postoperative). Level of activity was defined according to the 2000 International Knee Documentation Committee (IKDC) subjective knee evaluation form. (See Table 1 above for definitions.)

Preoperatively, 88 percent of patients described knee-related activity restriction. By the second week after the surgery, only 74 percent described knee-related activity restriction, a significant difference (p=0.039); this improved to 38 percent at four weeks, and to only 4 percent at 20 weeks. In addition, 82 percent of patients returned to light activity (such as walking, housework and yard work) after one week, 94 percent after two weeks and 100 percent after four weeks.

“Patients preparing to have knee arthroscopy are often told that the procedure has a rapid recovery...our results demonstrate that at four weeks postoperatively, a majority of patients (62 percent) returned to activity with no restrictions due to knee-related reasons,” reported the authors.

“Our results additionally demonstrate that knee arthroscopy is 20 weeks postoperatively only 4 percent of patients described knee-related activity restriction... [although] a minimum of 24 months of follow-up may be required to determine efficacy, and evaluation of efficacy was not our purpose.”

Although other studies have reported a faster return to activity than this investigation, those studies focused on athletes, rather than the diverse population of athletes and non-athletes in this study. “By design,” wrote the authors, “our series represents the real world of arthroscopic knee practice.”

The lead researcher for Paper 430 is James H. Lubowitz, MD, of Taos, N.M. and assistant editor-in-chief of Arthroscopy: The Journal of Arthroscopic and Related Surgery; additional authors include Myna Ayala, ST, also of Taos, N.M., and David Appleby, MPH, of Andover, Mass. The authors have a financial relationship (grant funding, consultant, or employee) with Smith & Nephew (Andover, Mass.) related to the topic of this manuscript.

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