Indianapolis, IN (Vocus) July 20, 2009
Research findings show that patients can significantly reduce their knee pain and improve their function with nonoperative treatment, allowing them to postpone or completely avoid total knee replacement surgery. The study, conducted by Dr. K. Donald Shelbourne, was the first study to document the effectiveness of increasing range of motion in the treatment of deconditioned and arthritic knees.
The study group included 50 patients (25 men, 25 women, mean age 53.2 years) with knee pain and range of motion loss compared to their opposite, normal knee. Most patients (41/50) had osteoarthritis of the knee and had been told by other physicians that they should have a total knee replacement. All patients underwent physical therapy including a daily home exercise program. The focus of the rehabilitation program was to improve range of motion, specifically the ability to completely straighten the knee. The goal was to restore symmetry compared to the opposite, normal knee.
Results of the Study
All patients had improvement in knee extension (straightening) and all but 4 patients had improvement in knee flexion (bending). As range of motion improved, International Knee Documentation Committee (IKDC) survey scores also improved, indicating lower levels of pain and disability.
Extension (straightening) deficit
Initial Evaluation 10°
Final follow-up 3°
Flexion (bending) deficit
Initial Evaluation 19°
Final follow-up 9°
IKDC survey score (out of 100 points)
Initial Evaluation 34.5
Final follow-up 70.5
Pain rating (0-10 scale)
Initial Evaluation 6.0
Final follow-up 2.5
Of the 50 patients in this study, all but 8 of them achieved adequate symptom relief with rehabilitation and decided against having surgery. The mean IKDC survey score at final follow up was comparable to what is considered a normal score for people aged 51 to 65. Patients reported decreased pain severity and frequency following completion of this rehabilitation program.
Components of the Treatment
Treatment involved a structured rehabilitation program focused on improving knee extension first, followed by knee flexion once progress on extension slowed. The final phase of rehabilitation focused on improving strength through quadriceps exercises and low impact exercise on a stationary bike, elliptical, or stair climber machine.
The Elite Seat®, manufactured by Kneebourne Therapeutic, was used with many of these patients to improve knee extension. This device can be used independently by the patient to provide a constant, prolonged stretch to the knee to improve extension and achieve hyperextension equal to the normal knee. The Elite Seat is also useful for treating any knee condition associated with extension loss including osteoarthritis, postoperative knee stiffness, acute anterior cruciate ligament (ACL) tears, and arthrofibrosis.
These findings highlight the efficacy of improving range of motion in patients with arthritic knees. Preoperative rehabilitation before ACL reconstruction surgery is now considered standard-of-care, but very few surgeons require preoperative rehabilitation before total knee replacement. Many patients are looking for ways to avoid having a knee replacement surgery, but are not given other options if medications fail to control their symptoms. This study shows that by implementing preoperative total knee replacement rehabilitation, many patients may be able to avoid surgery. For those patients who pursue the surgery, their recovery and outcome will be improved by maximizing the available range of motion before surgery.
About Dr. Shelbourne
K. Donald Shelbourne, M.D. began his Orthopaedic Sports Medicine career in 1982. Dr. Shelbourne graduated from Wabash College in 1972 with a major in chemistry. He completed Medical School and his Orthopaedic Residency at Indiana University Medical School from 1972 through 1981. Dr. Shelbourne obtained additional training by doing a Sports Medicine Fellowship with Dr. Bill Clancy at the University of Wisconsin in 1981-82.
Dr. Shelbourne served as the team physician for the Indianapolis Colts from 1984 through 1998, and has been an orthopaedic consultant to Purdue University, Wabash College, and area high schools since 1982. Dr. Shelbourne is an associate clinical professor at Indiana University School of Medicine at Indianapolis, Indiana. He has performed over 5000 ACL reconstructions and is best known for his advancement of ACL rehabilitation. He has published over 200 journal articles and chapters in books, and he has presented his findings at national and international meetings.
The Shelbourne Knee Center at Methodist Hospital in Indianapolis provides specialized, world-class care for knees. With a focus on continuing research and cutting-edge surgical and rehabilitation techniques, the staff at the Shelbourne Knee Center is committed to providing unsurpassed care to all patients, whether professional athletes or weekend warriors. The rehabilitation department specializes in the treatment of knee pain and knee injuries, providing patients with one-on-one care and education. Driven by research and evidence-based practices to provide the most up to date treatment and information, the Shelbourne Knee Center takes time to develop a treatment plan that meets your individual needs and helps you meet your goals. For more information, visit http://www.FixKnee.com.
bchaboude (at) aclmd (dot) com