A SHARED DECISION-MAKING™ PROGRAM
T R E AT M E N T C H O I C E S
FO R TO R N M E N I S C U S
This program content, including this booklet is copyright protected by Health Dialog Services Corporation (HDSC), a related entity of Bupa Health Dialog Pty Limited (Bupa Health Dialog), who is licensed to use the material in Australia. You may not copy, distribute, broadcast, transmit, perform or display this program or any part thereof, without permission from Bupa Health Dialog. You may not modify the contents of this program without permission from Bupa Health Dialog. You may not remove or deface any labels or notices affixed to the program package. © Bupa Health Dialog Pty Limited 2012
As Bupa’s Chief Medical Officer I’m delighted to introduce Bupa’s Treatment Choices for Torn Meniscus after age 40 Shared Decision Guide. Making decisions about the steps needed to improve your health and make more informed choices can be complicated. This guide offers practical advice to help you better understand your condition and treatment choices, and support your discussion with your treating health professional.
By keeping better informed you can be more confident that the care you receive is appropriate to your personal circumstances, priorities and preferences.
We are grateful to Associate Professor James Sullivan,1 at Macquarie University Hospital and
Professor Mark Harris2 and his team3 from
the University of NSW who have reviewed this valuable tool. They have confirmed that it is based upon high quality, evidence based resources, and aligns with current Australian practice and guidelines.
We hope this Shared Decision Guide will be useful to you and your health professional when you are needing to make decisions together about yours or your family’s health and health care.
Important instructions:
° The information in this program is not intended to be medical advice, a diagnosis of your condition, or a treatment recommendation. It is intended to
help you learn about your symptoms, conditions, and various options so that you can participate more effectively in making decisions about your health with your doctor.
° Not all of the options discussed may be
appropriate for your individual medical situation. Talk with your doctor about how the information presented relates to your specific condition.
° Bupa Health Dialog does not approve or
authorise care or treatment. If you have questions about whether a particular treatment is covered by your private health insurance, please contact your private health insurer.
For more information
° Visit bupa.com.au
F O R E W O R D
1Associate Professor James Sullivan is Head of Arthroplasty, Australian School of Advanced Medicine, Macquarie University. 2Mark Harris is foundation Professor of General Practice and Executive Director of the Centre for Primary Health Care and
Equity at UNSW.
3
ABOUT THIS PROGRAM
What is Shared Decision-MakingTM? 4
Communicate openly with your healthcare provider 4 About Shared
Decision-MakingTM Programs 4
How can this program help you? 4
Are the options discussed in this program appropriate for you? 5 Who made this program? 5
Who are the people in
this booklet? 5
How can you know if the information in this program is up-to-date?
5
INTRODUCTION
How can this booklet help you? 7
Be sure this information is right
for you! 7
KEY FACTS TO KNOW
Real people tell real stories 9
About the meniscus 11
IS YOUR PAIN FROM
A TORN MENISCUS?
What do symptoms and MRIs
tell you? 13
Overview of treatments for torn meniscus symptoms 15
TR E ATM ENT
C H O I C E S FO R
TO R N M EN ISCUS
TORN MENISCUS WITH
OSTEOARTHRITIS
Meniscus tears and arthritis
often go together 16 Arthroscopic surgery does not
help arthritis pain 18
EXERCISE THERAPY
How does exercise therapy help? 21
Exercises for a torn meniscus 22
Exercising with arthritis 23
PAIN MEDICATIONS
Medications that may be helpful 24
Medication side effects and
safety tips 25
ARTHROSCOPIC SURGERY
Arthroscopic surgery for a
torn meniscus 28
Risks and recovery after
arthroscopic surgery 30
MAKING YOUR DECISION
What should you ask your doctor 32
How do you feel about surgery and recovery when the chance of improvement is uncertain?
32
How would you manage your
symptoms without surgery? 32
DEFINITIONS OF
MEDICAL TERMS
34FOR MORE INFORMATION
35WHAT IS SHARED DECISION - MAKING™ ?
Shared Decision-Making™ is working with your doctors and other healthcare professionals to make decisions about your care. In Shared Decision-Making™, your doctor is the expert in medicine, but you are the expert on how you feel and what’s important to you. Together you make up a decision-making team. Family, friends, and other healthcare providers may also be part of this team.
Participating in healthcare decisions helps ensure that you are getting the care that best meets your needs. To do this, you’ll need to be informed about your condition and the different ways to manage it. You’ll also need to think about how each management approach can affect you so that you can choose what makes the most sense for you.
CO M M U N I C AT E O P E N LY W I T H YO U R H E A LT H C A R E P R OV I D E R
Getting good care also requires good communication between you and your healthcare team. To get the right care, you and your doctor or other healthcare professional, need to talk about your health goals and what you’re able to do to protect or improve your health.
A B O U T S H A R E D
D EC I S I O N - M A K I N G ™ P R O G R A M S
This Shared Decision-Making™ program is provided through Bupa Health Dialog for your individual use. The program is designed to support your participation in an informed dialogue with your healthcare provider as you work together to make important decisions about your health. Shared Decision-Making™ programs are based on medical evidence researched and evaluated by the Informed Medical Decisions Foundation.
The Informed Medical Decisions
Foundation has been working for over two decades to advance evidence-based shared decision making through research, policy, clinical models and patient decision aids. Visit informedmedicaldecisions.org for more information.
H OW C A N T H I S P R O G R A M H E L P YO U ?
The information in this program can help you prepare to talk with your doctor so you are ready to ask questions and discuss how you feel about your healthcare options. Then you and your doctor can talk about which option may be best for you and make a decision together—a shared decision. You might be wondering, is this information right for me? Where did it come from? How can I use it? In this program, you’ll find answers to these and other questions you may have.
ABOUT TH IS PROG R AM
A B O U T T H I S
P R O G R A M
A R E TH E O P TI O N S D I SC U S S ED I N TH I S P R O G R A M A P P R O P R I AT E FO R YO U ?
Some of the options in this booklet may not be appropriate for your individual medical situation. Talk with your doctor about how the information in this program relates to your specific health condition. Note that neither Bupa Health Dialog or any of its related entities approve or authorise care, treatments or tests. The care, treatments or tests
described in this program may not be covered by your private health insurance. If you have questions about whether your private health insurance provides cover in respect of a particular treatment or test, speak with your private health insurer or your doctor.
W H O M A D E T H I S P R O G R A M ?
Bupa Health Dialog and the Informed Medical Decisions Foundation produced this program booklet. In accordance with the relevant requirements of the licence provided to Bupa Health Dialog, it has been adapted from the original version produced for use in the United States. Information regarding suitability for publication in Australia was provided by the University of New South Wales Centre for Primary Health Care and Equity. To ensure the content is appropriate and acceptable for Australian consumers and health professionals, Australian clinical practice guidelines have been reviewed and the Australian healthcare system, language and culture taken into account.
Bupa Health Dialog does not profit from any of the treatments discussed in the program.
W H O A R E T H E P EO P L E I N T H I S B O O K L E T ?
The people who are quoted in this booklet volunteered to share their stories about how they decided to treat a torn meniscus. They received a small fee for their time. They do not profit from recommending any treatment or self-care strategy. These people were chosen because their stories show many of the reasons people have for making different treatment choices.
The physician featured in this booklet is Dr. John Wright. He is an orthopaedic surgeon who specialises in treating
osteoarthritis of the knee.
H OW C A N YO U K N OW I F T H E I N FO R M AT I O N I N T H I S P R O G R A M I S U P -TO - DAT E ?
All booklets are reviewed regularly and updated. If you received this program some time ago, or if someone passed it along to you, do not use it. The information may be out of date. To make sure you have the most recent program, please visit bupa.com.au. Please use the product number located on the back of the booklet to determine if you have the most recent copy.
A B O U T T H IS P R O G R A M
H OW C A N T H I S B O O K L E T H E L P YO U ?
You’re probably reading this booklet because you have a knee problem, and your doctor has told you that your symptoms could be from a torn meniscus. Your symptoms may include pain, stiffness, a catching feeling in the knee, and difficulty walking.
This booklet will help you understand your knee problem and your treatment
options—exercise, pain medication, or
arthroscopic surgery to remove the torn or damaged part of the meniscus. After you’ve learned about your options, there’s a chapter called Making Your Decision at the end of this booklet that will help you think about what you want to do to help your knee. This information can help you get ready to talk with your doctor and make an informed decision about the treatment that’s best for you.
B E S U R E T H I S I N FO R M AT I O N I S R I G H T FO R YO U !
This booklet includes information from recent medical studies about treating meniscus tears that happen as people age. But this information does not apply to everyone who has a torn meniscus. This information is right for you if all these things apply to you:
° You are 40 or older.
The meniscus changes with age. The studies used to write this booklet looked at treating meniscus tears in people 40 and older. Younger people may have different treatment options and results.
° Your doctor told you that a tear in your
meniscus is the likely cause of your knee symptoms.
Not all meniscus tears cause problems.
° You may or may not have osteoarthritis
in the knee.
The studies in this booklet included people with knee osteoarthritis (often called arthritis) because it is common among people 40 and older who have a meniscus tear.
I N T R O D U C T I O N
INTRO D U C TI O N
This information is not right for you if any of these things apply to you:
° You are younger than 40.
The information in this booklet comes from studies of people 40 and older. If you’re younger than 40, the results may not apply to you and you may have different treatment options.
° You have a type of arthritis other than
osteoarthritis (for example, rheumatoid arthritis).
This booklet talks about treating a torn meniscus in people with osteoarthritis. It does not include information about other types of arthritis.
° Your doctor has recommended surgery to
stitch together the tear in your meniscus. This type of arthroscopic surgery isn’t included in this booklet because after age 40, the meniscus is usually too worn and fragile to stitch back together. For people 40 and older, arthroscopic surgery is usually done to remove torn and damaged pieces of meniscus—not to stitch the tear together.
° Your knee osteoarthritis bothers you so
much that you would consider having a knee replacement.
People with severe osteoarthritis may choose knee replacement surgery when nonsurgical approaches no longer help. If your knee pain is this bad, you may want to talk to your doctor or Health Coach about deciding whether to have knee replacement surgery.
° Your knee locks, or gets stuck, in a bent
or straight position for a long time. When this happens you need to massage it or make other efforts to get it moving again. This booklet is about choosing a treatment for your knee. But if your knee locks, arthroscopic surgery may be your only treatment option. You can still use this information to learn about meniscus tears and what happens during arthroscopic surgery and recovery.
Note: Italics are used in this booklet to emphasise key words or to identify medical terms. See the Definitions of medical terms section at the end of the booklet for full descriptions of medical terms that are italicised.
W H Y A R E T H E S E K E Y FAC T S S O I M P O R TA N T ?
Some health problems have one treatment. For example, if you break a bone in your arm there’s no decision to make—you’ll probably have a cast for a while.
The treatment for a torn meniscus after age 40 is not so clear-cut. You have choices:
° you can wait to see if your symptoms get
better without treatment
° you can choose to try exercise
° you can use pain medication temporarily to reduce pain
° you can choose to have arthroscopic surgery to remove the torn or damaged parts of the meniscus.
To make an informed decision, you need to understand the following key facts.
° A torn meniscus may not be the cause of
your symptoms.
If you have a meniscus tear and
symptoms—like knee pain and problems doing the things you want and need to do—you may think that the meniscus tear is the cause. But that may not be true. A different knee problem could be causing your symptoms.
Some meniscus tears (also called meniscal tears) don’t cause any symptoms. And other knee conditions can cause symptoms a lot like a torn meniscus. This makes it impossible for doctors to know for sure when a torn meniscus is the cause of knee pain.
° Torn meniscus and osteoarthritis
often go together.
People over 40 who have tears in a meniscus often have knee osteoarthritis, too.
Osteoarthritis is commonly called arthritis.
Having both a torn meniscus and arthritis makes it harder to know which problem is causing the symptoms that bother you.
° Exercise can help relieve knee pain.
Exercise is generally safe and helpful for different types of knee problems, including meniscus tears and arthritis. Many people try exercises before considering arthroscopic surgery for a torn meniscus. Taking time to try exercise will not affect the results of arthroscopic surgery if you decide to have it later.
° Arthroscopic surgery for torn meniscus
pain may not be better than exercise. There hasn’t been enough research on arthroscopic surgery for a torn meniscus to know if it is better for pain relief than knee exercises and pain medication.
If exercises don’t help enough, arthroscopic surgery may be a reasonable choice for some people who have symptoms that seem to be from a torn meniscus. But having a torn meniscus doesn’t mean you need to have surgery.
° Arthroscopic surgery does not help pain
from arthritis.
If arthritis is the most likely cause of your discomfort, arthroscopic surgery will not help. Medical experts used to think that arthroscopic surgery could help arthritis, but now they know it does not.
KE Y FAC TS TO KNOW
K E Y FA C T S
TO K N O W
K E Y F A C T S T O K N O W
If you’re considering arthroscopic surgery for a torn meniscus and you also have arthritis, it’s important to ask your doctor which problem is most likely causing your knee pain.
R E A L P EO P L E T E L L R E A L S TO R I E S Steve K, age 59
Condition: torn meniscus, mild arthritis.
Treatment: after trying exercise, Steve chose
arthroscopic surgery.
Result: Steve recovered quickly and is nearly
pain free.
Steve’s knee pain was so bad that he could not sit at his desk in the office for long without getting up and walking around to stretch his legs. “I would make frequent trips down the hall to use the lavatory, I would go get a drink from the vending machine just as a way to stretch my legs,” he says. This would continue all day and interfered with his work. Steve wanted to get back to playing active sports, including running. He tried physiotherapy and it did not work. He then chose arthroscopic surgery.
Steve recovered quickly and is nearly pain free. “Physiotherapy wasn’t successful for me, it was from that point forward that I worked with a specialist to come to the decision I did regarding surgery.”
Marcia E, age 61
Condition: torn meniscus, mild arthritis.
Treatment: exercise.
Result: Marcia is satisfied with the improvement
in her knee pain and is able to lead an active life. Marcia taught in preschool and kindergarten classrooms and would sometimes sit in very low chairs, which caused a lot of pain. “I would have to stretch my leg out straight because it would be very painful.”
She started to notice the pain when she walked. Her doctor told her that she had a torn meniscus and some osteoarthritis. Her doctor explained that exercise could help relieve her knee pain. “Initially, I really didn’t understand how exercise could affect the pain and the problem I was having,” she says. “But the doctor and his team took the time to explain it and the physiotherapist followed up with explanations of what she was doing and how that would make a difference. Then I understood it.”
Marcia’s healthcare team helped her
understand how doing exercises to strengthen the leg muscles could help her knee pain. She continues with her exercises and is satisfied with the improvement.
Beryl A, Late 50s
Condition: torn meniscus, arthritis.
Treatment: two arthroscopic surgeries
on one knee.
Result: After an unsuccessful first surgery, Beryl
has had some relief from a second surgery. Beryl had severe pain in her knee. “When I went to see the doctor, I was having terrible, terrible pain, excruciating pain in my knee,” she says. “I wasn’t so much of an astute student, in terms of my healthcare, at the time. So I did not do the research. I didn’t know what important questions to ask.”
Beryl had arthroscopic surgery but it did not help relieve her pain. She had a second surgery on her knee, which has given her some relief. “I’m not 100%, but I’m at a point where I can live with the pain,” she says.
Many people think that because the meniscus is torn ... they need to have surgery to address it. But the meniscus being torn is only important if you’re having pain and disability because of it. We also know that in many instances, a meniscus tear that causes pain initially may settle down over time.
A B O U T T H E M E N I S C U S In this chapter:
° The meniscus is like a cushion that pads
the knee
° As you age, the meniscus can tear more easily
° A torn meniscus doesn’t always hurt
The meniscus is like a cushion that pads the knee
The meniscus is a disc of tissue that works like padding between the thighbone and shinbone. It cushions impact when you walk, run, and jump. The meniscus also helps spread your body weight evenly over the entire knee. Each knee has two meniscus discs. They are each shaped like the letter C.
Ligaments are strong bands of tissue that connect the bones of the upper and lower leg and help keep the joint stable. Muscles (not shown in the illustration on the right) also help support the knee. The illustrations onthe right show a normal knee and a knee with a meniscus tear.
As you age, the meniscus can tear more easily Meniscus tears are common among people 40 and older. In young people with healthy knees, the meniscus is difficult to tear. With age, the meniscus can become thin and fragile like worn, frayed cloth. Sometimes parts of the meniscus wear away completely. A weak meniscus can tear easily during normal activity that puts stress on the knee. For example, getting in and out of a car or squatting down can damage a thin meniscus. You may remember doing something that suddenly started your knee pain, or your symptoms may begin slowly so that you don’t know exactly how or when they started.
A torn meniscus doesn’t always hurt Meniscus tears often don’t cause any problems and don’t need treatment. But some meniscus tears cause pain, stiffness, and other problems.
Your doctor will try to find out what seems to be causing your symptoms—a meniscus tear or another knee problem. This is important because your treatment options depend on what’s causing the problem.
K E Y F A C T S T O K N O W
When you’re older, the trauma to the knee may not be noticed. It may be multiple small injuries over a period of time that lead to the tearing of the meniscus. Dr John Wright
The meniscus cushions impact and helps spread body weight over the entire knee.
Normal knee
With age, the meniscus can become thin and fragile. Knee with meniscus tear
WHAT DO SYMPTOMS AND MRIS TELL YOU? In this chapter:
° Symptoms of a torn meniscus are like other
knee problems
° MRIs show meniscus tears, but not the likely
cause of pain
° MRIs aren’t always necessary
° When should you see a specialist and
what type?
Symptoms of a torn meniscus are like other knee problems
Symptoms of a torn meniscus can include:
° pain that you feel in one specific part of
your knee
° popping, clicking or catching feelings when you move your knee in certain ways, or a feeling that something is getting stuck in your knee (these feelings are often called “mechanical symptoms”)
° “buckling” or giving way in your knee.
If you have one or more of the symptoms listed on this page, a tear in your meniscus could possibly be the source of your pain. But other knee problems can also cause these symptoms:
° a new, sharp knee pain that starts suddenly ° stiffness
° swelling
° pain only during certain movements, such as twisting or pivoting.
These symptoms may be mild or severe enough to make walking and daily activities difficult. Sometimes symptoms from a torn meniscus go away on their own.
MRIs show meniscus tears, but not the likely cause of pain
A magnetic resonance imaging (MRI) scan can show a tear in your meniscus, where the tear is, and how large it is. An MRI can’t tell you for sure whether a meniscus tear or something else is the reason for your symptoms. Remember, meniscus tears don’t always cause pain. It’s possible that your symptoms are from arthritis, or another type of knee problem that an MRI may or may not show.
IS Y O U R P A IN F R O M A T O R N M E N IS C U S ?
I S YO U R PA I N
F R O M A TO R N
M E N I S C U S ?
My knee pain came on suddenly ... I was not able to carry out my duties at work as well as I should have.
Beryl
The problem with the MRI scan is that it’s very sensitive. It finds all kinds of things. But it doesn’t necessarily tell us which of the things that it finds are the actual cause of the problem. That’s why the history and then the physical exam are necessary to decide what the actual cause is.
IS YOU R PAIN FRO M A TO RN M EN ISCUS ?
To find out if a meniscus tear is the most likely reason for your pain, your doctor will:
° ask you about your symptoms and how
they started
° examine your knee
° look at the results of an MRI, if you’ve
had this test.
MRIs aren’t always necessary
You don’t need an MRI if you want to try helping your knee with exercise or pain medication. That’s because these approaches can help many types of knee problems, so you don’t need to know for sure that your meniscus is torn before you try them. You do need an MRI to make sure your meniscus is really torn if you’re considering arthroscopic surgery. But it’s important to remember that an MRI may find tears that are painless. That’s why the decision to have arthroscopic surgery for a torn meniscus should never be based on an MRI alone.
When should you see a specialist and what type?
If you don’t want to consider surgery, you probably don’t need to see a specialist. Your GP can help you manage your knee symptoms or refer you to a trained professional who will teach you exercises that can help.
You may want to see a specialist if:
° you would consider having arthroscopic surgery and your GP thinks it could help your symptoms
° you want more information about what is
going on in your knee.
Orthopaedic surgeons and rheumatologists
are doctors who have had special training to evaluate joint problems. They can provide more complete information about your knee and can help you decide if arthroscopic surgery is a reasonable option for you. Remember, even a specialist can’t be 100% sure about the cause of your knee pain.
IS Y O U R P A IN F R O M A T O R N M E N IS C U S ? OV E RV I E W O F T R E AT M E N T S FO R TO R N M E N I S C U S S Y M P TO M S In this chapter:
° You have time to try exercise therapy and
pain medication
° Arthroscopic surgery removes torn parts of the meniscus
° Why not stitch a torn meniscus together?
If a doctor thinks that a meniscus tear is the most likely cause of your symptoms, you have a choice about what to do—and time to decide. A torn meniscus is not an emergency. There is no reason to rush to have surgery.
You have time to try exercise therapy and pain medication
Taking time to try exercise will not affect the results of arthroscopic surgery if you decide to have it later. Some people get pain relief after several weeks of exercising . Exercise works mainly by increasing the strength in the muscles around the knee so that they support the joint better. Some people also use pain medication for a short time to help with discomfort.
If exercise and pain medications do not help enough and the symptoms make it hard to get around, some people consider the pros and cons of having arthroscopic surgery.
Arthroscopic surgery removes torn parts of the meniscus
Arthroscopic surgery is also called arthroscopy. It is a surgery that uses three small incisions around the knee.
In one incision, the surgeon inserts a video camera about the size of a pencil. The camera shows the inside of the knee on a TV screen. The surgeon inserts surgical tools into the other two incisions. Surgeons use arthroscopic surgery to do different types of procedures. For a torn meniscus in people 40 or older, arthroscopic surgery is done to remove torn and damaged parts of the meniscus, leaving as much of the meniscus in the knee as possible. This procedure is called a partial meniscectomy.
The surgery typically takes an hour or less, and people usually go home the same day. Doctors often recommend exercise to help with recovery.
Why not stitch a torn meniscus together? You may have heard about someone who had arthroscopic surgery to stitch the meniscus tear back together. This surgery sometimes works for people younger than 40.
In people 40 and older, the meniscus is usually too thin and worn to be stitched together. So instead, the surgeon removes the torn parts of the meniscus that may be causing symptoms. If you’re in your early 40s, you may want to know if your meniscus is still in good enough condition to be stitched together. Your doctor can discuss this with you.
But if your doctor recommends arthroscopic surgery involving stitches, or sutures, to sew together a tear in your meniscus, the information in this booklet is not right for your condition.
TO R N M EN ISCUS WITH OSTEOARTH RITIS
TORN
M EN ISCUS WITH
OSTEOARTH RITIS
M E N I S C U S T E A R S A N D A R T H R I T I S O F T E N G O TO G E T H E R In this chapter:° Arthritis affects the entire knee joint
° Meniscus tears and arthritis have similar symptoms
° Doctors use several types of information to
find the likely cause of symptoms
People over 40 who have tears in a meniscus often have knee arthritis too. Having both problems makes it harder to know which one is causing the symptoms that bother you. Arthritis affects the entire knee joint In a normal knee, smooth, firm cartilage
covers the knee bones and helps them glide easily when you move.
When people have arthritis, the cartilage on the bones wears away and becomes rough.
Bone spurs are another sign of arthritis. When cartilage in the knee wears away, bone spurs form as the body tries to make up for this damage. In a knee with arthritis, the meniscus may tear or completely wear away over time.
Arthritis can cause pain and stiffness. Your knees may swell or be painful to bend. These symptoms can make it hard to walk or do daily activities.
Arthritis doesn’t go away. Symptoms can get worse over time or stay the same for years. Sometimes pain and the ability to move will get better. But, there’s no way to predict what will happen to your symptoms over time. The illustrations on the next page show a normal knee compared to a knee with arthritis and a meniscus tear.
Both the arthritis and the meniscal tear may be causing pain. The treatment for the two can be quite different. So, it’s important to get an understanding of which of them is causing which parts of the pain and what needs to be addressed. Dr John Wright
T O R N M E N ISCU S WITH OS TEO A RTH R ITI S
Possible symptoms Torn meniscus Knee arthritis
Swelling/Stiffness Common Common
Knee “buckles” or gives way
Common Common
Catching, clicking or popping feelings
Common Less common
Pain ° often a sharp pain that may
start suddenly
° in one area of the knee ° happens predictably with
certain movements, like turning or squatting.
° usually a dull ache that
comes slowly over time; sometimes a sharp pain
° usually the whole knee ° may come and go ° worse after standing or
walking for a long time. Meniscus tears and arthritis have similar symptoms
A torn meniscus and arthritis can cause the same types of knee pain. If you have both problems, it’s impossible to know for sure which one is causing pain. The table below shows symptoms that could be caused by a torn meniscus or arthritis.
Knee with arthritis and a meniscus tear
In a knee with arthritis, the cartilage on the bones wears away and becomes rough. Bone spurs are another sign of arthritis. The meniscus may tear or completely wear away over time.
Normal knee
In a normal knee, smooth, firm cartilage covers the knee bones and helps them glide easily when you move.
TO R N M EN ISCUS WITH OSTEOARTH RITIS
Doctors use several types of information to find the likely cause of symptoms
To find out whether arthritis or a torn meniscus is the likely cause of your knee problem, a doctor will examine your knee, ask you about your symptoms, and look at plain x-rays and sometimes, MRIs.
Both x-rays and MRIs can show how much arthritis you have. But the amount of arthritis shown on pictures may have little to do with the amount of pain and other symptoms you have.
° Some people feel a lot of pain from the early
stages of arthritis, but their x-rays and MRIs show little or no arthritis.
° Other people feel little or no pain, but their
x-rays and MRIs show a lot of arthritis
.
Arthritis Tornmeniscus
Cause of pain
MRI Yes Yes No
X-ray Yes No No
It’s important to remember: x-rays and MRIs cannot tell you if your symptoms are coming from arthritis, a torn meniscus, or another knee problem that may not show on pictures. That’s why treatment decisions should not be made on x-rays and MRIs alone.
If you have knee arthritis and you’re considering arthroscopic surgery for a meniscus tear:
° make sure to tell your doctor which
symptoms bother you the most
° then ask if arthritis seems to be the cause
of those symptoms.
If your doctor thinks that some or all of your symptoms are from arthritis, you can learn how exercise can help knee pain in this booklet.
A R T H R O S CO P I C S U R G E RY D O E S N OT H E L P A R T H R I T I S PA I N
In this chapter:
° One study compared arthroscopic surgery
and nonsurgical treatments for arthritis
° Arthroscopic surgery plus nonsurgical treatments didn’t help more than nonsurgical treatments alone
Doctors used to think they could help knee arthritis symptoms by doing arthroscopic surgery to smooth the rough surfaces in the joint and to remove loose pieces of bone, cartilage, and meniscus.
Now, medical studies show that arthroscopic surgery for arthritis does not reduce arthritis pain or make it easier to do everyday activities better than nonsurgical treatments, like exercise and pain medication.
This chapter gives you information about a study that showed arthroscopic surgery does not improve pain from knee arthritis.
One study compared arthroscopic surgery and nonsurgical treatments for arthritis One large, good study looked at 178 people who were divided into two groups.
People in both groups:
° had moderate to severe knee arthritis
on x-rays
° used nonsurgical treatments, including
exercises, pain medication, and cold and heat treatment
° learned about arthritis and how to avoid pain doing daily activities.
One of the two groups also had arthroscopic surgery for arthritis symptoms.
T O R N M E N ISCU S WITH OS TEO A RTH R ITI S
Arthroscopic surgery plus nonsurgical treatments didn’t help more than nonsurgical treatments alone
Two years after treatment, people who had nonsurgical treatments improved as much as people who had arthroscopic surgery plus nonsurgical treatments, as shown in the chart below.
Two years after treatment, people rated their symptoms the same, whether they had arthroscopic surgery or not. Symptoms included pain, stiffness and difficulty doing daily activities such as climbing stairs, housework, shopping and getting in and out of the car.
People in both groups rated their symptoms the same—between “mild” and “moderate”. On average, everyone in the study had:
° less pain ° less stiffness
° less difficulty doing daily activities like
climbing stairs, housework, shopping and getting in and out of a car.
Adding arthroscopic surgery to nonsurgical treatments did not make a difference. The study also looked at surgery results for people who had moderate, but not severe, arthritis before treatment. Arthroscopic surgery did not help these people either. The results of the study are clear: Arthroscopic surgery did not help pain or other symptoms of knee arthritis. Arthroscopic surgery doesn’t help more than nonsurgical treatment
H OW D O E S E X E R C I S E T H E R A P Y H E L P ? In this chapter:
° Exercise therapy strengthens muscles and reduces pain
° Three types of exercise improve strength, balance and movement
° Professionals can help you get started ° It may take several weeks to feel better ° If exercises don’t help, you can still
consider surgery
° Exercising with arthritis
Exercise can help relieve symptoms from a torn meniscus and knee arthritis.
Exercise strengthens muscles and reduces pain
When your knee hurts, you may have a hard time thinking about exercise. But exercise can help your knee feel better over time because it can strengthen the muscles that support your knee and help your knee move better. Many doctors recommend exercise for at least a couple of months for most people who have a torn meniscus—with or without arthritis.
Three types of exercise improve strength, balance, and movement
To ease knee pain and other symptoms of arthritis, it helps to do three types of exercises.
1. Exercises to strengthen the muscles around the knee
When your knee hurts, it’s natural to want to limit your activity. But if you don’t use your muscles, they can become weak. Weak thigh muscles can’t support the knee, and that can cause more pain.
Exercises that strengthen your thigh muscles can help your knee feel better and prevent your pain and other symptoms from getting worse. Strong thigh muscles help support your knee. They absorb the impact when you move, and they can help you stay active longer.
2. Exercises to improve balance
Knee problems can make your knee less stable, which can affect balance and coordination. Doing exercises to improve your balance improves the stability of your knee and your muscle coordination.
3. Exercises to improve movement
Range-of-motion exercises and stretching can reduce stiffness and help you move more comfortably.
°Range-of-motion exercises help the knee
joint move farther in all directions.
°Stretching exercises make your muscles
more flexible. EX ER C ISE T H ER A P Y
E X E R C I S E
T H E R A P Y
E XERCIS E TH ER APY
Professionals can help you get started You may find it helpful to work with a trained professional who can teach you knee exercises that you can continue to do on your own.
Physiotherapists, sports medicine physicians,
and exercise physiologists are some of the professionals who can show you which exercises are right for you, how to do them correctly, and how often to do them. Your GP may be able to recommend someone who can help you.
It may take several weeks to feel better You may need to do exercises for several weeks or more before you notice improvement, so patience is important. Exercise may not get rid of all your symptoms, but it can reduce your pain and increase your ability to do the things you want and need to do.
To keep your knee as comfortable as possible, it’s a good idea to continue doing exercises even after your symptoms improve.
These tips can help you stick to your exercise and get the most out of it:
° Exercise at a time of day when you have the
least stiffness and pain.
° If you have pain when you exercise, try
taking pain medication before exercising. Some discomfort is normal, especially when you start exercising for the first time. If you have serious pain, talk with your doctor.
° Exercise regularly. Try to exercise at least
two to three times a week, for 30 to 60 minutes each time.
° Be patient. It may take several weeks, or even a few months, to feel improvement. If exercises don’t help, you can still consider surgery
If you find that exercise and other
nonsurgical treatments don’t improve your symptoms enough, you can still consider having surgery if your symptoms are likely to be from a torn meniscus.
Taking time to try exercise will not affect the results of arthroscopic surgery if you decide to have it later.
The next two sections give more information on exercises for a torn meniscus and for arthritis.
Exercises for a torn meniscus
The exercises listed below have helped some people with symptoms that seemed to be from a torn meniscus.
These exercises are safe for people who also have arthritis:
° riding a bicycle or stationary bicycle ° leg presses with weights
° lunges
° bending (flexion) and straightening
(extension) the knee against resistance to strengthen muscles
° jogging or jumping on a mini trampoline ° balancing on a wobble board
° standing on one leg for balance ° calf raises (lifting up on your toes).
Before starting any exercise program, it’s a good idea to check with your doctor that the exercise program is safe for you. A physiotherapist, sports medicine physician or an exercise physiologist can show you how to do the exercises correctly and safely.
I started feeling an improvement within a few weeks and I did stay doing the exercises pretty regularly. It certainly helped to have the check-in with the physiotherapist weekly because if I cut back, she would let me know that I wasn’t doing as well.
When you first start doing these exercises, your knee may hurt more for a while. This is normal and usually gets better as you become used to doing the exercises. Some people use pain medication to help get through the temporary discomfort from doing new exercises.
Exercising with arthritis Exercise therapy can help
If you have knee arthritis, exercise therapy to strengthen the muscles that support your knee can help you feel better. The exercises for a torn meniscus listed on the previous page are safe and helpful for people who have arthritis symptoms, too.
Exercises using elastic bands (also called resistance bands) are another way to strengthen your muscles.
Get enough regular aerobic exercise
It’s helpful to get enough regular aerobic exercise, such as walking or swimming, to make your heart pump faster. Exercise that doesn’t put a lot of impact on your knees is generally good for people with knee arthritis—for example, walking, riding a bicycle, swimming and pool exercises. Getting regular exercise can help you:
° build stronger muscles
° improve your overall physical fitness ° reduce stiffness and make you more flexible ° boost your energy and mood.
Some activities can worsen arthritis symptoms
Exercise activities and sports that require jumping on hard surfaces, twisting or fast turns (for example, basketball or soccer) may not be good for people with knee arthritis. These activities can hurt more than help, because they may put too much stress on the knee.
Before you choose an exercise, get advice from your doctor, physiotherapist, or exercise physiologist to find out what will be safe for you.
EX ER C ISE T H ER A P Y
There are many … low-impact exercises that you can do that will build strength but not aggravate the pain. It’s important as you start to exercise to expect that you’re going to have some discomfort. So you need to have a program that’s not painful and will start out very gradually.
Dr John Wright
When I go to the gym, I use different machines that keep those muscles strong that align with the knee. I’m really glad I made that decision, it really worked. Marcia
PAIN M EDIC ATIO NS
PA I N
M E D I C AT I O N S
M E D I C AT I O N S T H AT M AY B E H E L P F U L In this chapter:
° Paracetamol is safe for most people
° NSAIDs reduce pain and swelling, but have more risk
° An NSAID skin gel may have fewer risks ° Doctors usually don’t recommend opioids
for knee arthritis or a torn meniscus Paracetamol is safe for most people Paracetamol relieves pain and is generally safe for most people if they follow directions. The biggest risk from paracetamol is taking too much, which can damage the liver. The risk of liver damage may be higher in people who drink alcoholic beverages while taking paracetamol. If you have liver disease, talk to your doctor before taking paracetamol. Other medications you take may contain paracetamol. You’ll need to read labels to make sure you’re not getting too much. Medications that contain paracetamol include:
° over-the-counter cold and cough medicines ° prescription and non-prescription medications
containing combination paracetamol and codeine—an opioid painkiller.
NSAIDs reduce pain and swelling, but have more risk
NSAIDs stand for Nonsteroidal
Anti-Inflammatory Drugs. NSAIDs relieve pain and reduce swelling. They come in over-the-counter and prescription versions.
You can buy these NSAIDs without a prescription:
° diclofenac ° ibuprofen ° naproxen.
Prescription NSAIDs may not relieve pain more than the ones you can buy
over-the-counter. Some prescription NSAIDs are higher doses of the same ingredients in over-the-counter products, like ibuprofen and naproxen. Some over-the-counter painkillers are available in higher doses by prescription; however, there’s no good evidence that higher doses are any better at relieving pain than the same doses of the over-the-counter versions.
The risks are the same for over-the-counter and prescription NSAIDs.
The most common side effects of NSAIDs are problems with stomach irritation that can lead to bleeding or ulcers. Less commonly, people taking NSAIDs develop kidney or heart problems and high blood pressure. Only take NSAIDs for short periods of time (up to three weeks) and talk to your doctor before taking an NSAID if you have had stomach ulcers, asthma, or kidney problems. A new class of NSAIDS called COX-2 medications (e.g. celecoxib) were introduced some years ago. Although some studies found these had fewer stomach side effects than standard NSAID, other studies have not found a difference. There is also a slight increase in risk of heart attack with these medications.
P A IN M E DICA T IONS
There are things you can do to lower the risk of problems from NSAIDs:
° Don’t take two different NSAIDs together
(like naproxen and ibuprofen) unless your doctor tells you it’s okay.
° Ask your doctor about lowering your chance of stomach upset and ulcers by taking proton pump inhibitors with an NSAID. Proton pump inhibitors include: esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.
° Ask your doctor if an NSAID skin gel is a
good option for you.
An NSAID skin gel may have fewer risks An NSAID skin gel is a product that you can rub directly on your knee.
Studies show that NSAID gels can help relieve pain from osteoarthritis as well as the pill version of the same drug, but with fewer side effects.
Some people have skin irritation from the gel. In rare cases, the gel may cause liver problems. More study is needed to find out if an NSAID gel is safe to use for a long time. Doctors usually don’t recommend opioids for knee arthritis or a torn meniscus Opioid pain medications, including codeine, pethidine and morphine are strong pain medications. Doctors generally do not recommend opioids for relief of knee pain from arthritis or a torn meniscus because they can have serious side effects, and they can become habit-forming.
M E D I C AT I O N S I D E E F F EC T S A N D S A F E T Y T I P S
Possible side effects
The table on page 27 shows the possible side effects from many prescription and over-the-counter pain relievers.
This information can help you talk with your doctor about which medication may be best
for you.
Simple safety tips
Prescription and over-the-counter pain medications can provide temporary relief from knee pain. All medications can cause side effects, so use them with care. To avoid problems while using pain medication:
° Make a list of everything you already
take, including:
– prescription medications
– over-the-counter medications
– vitamins
– herbal or other dietary supplements.
° To avoid serious problems from drug interactions, show your list to your doctor and pharmacist. Ask them if a new medication could interact with anything you are taking.
° Ask your doctor if the pain medication
could affect any other health conditions you have.
° Read all labels and make sure you follow
the directions.
° Try not to use pain medications regularly
for long periods of time. Long-term use increases your chance of having side effects. Ask your doctor how long you can safely take a pain medication.
° Use medications for short periods. Some
people take medication for a brief time to help with:
– sudden pain flare-ups
– activities that increase pain, like starting to exercise
– activities that they want to enjoy, such as going to a special event.
° Take the lowest dose possible to reduce
the chance of having a problem.
° Stop taking medication when your pain improves.
Medication type Active ingredient Possible side effects
Analgesics paracetamol ° liver damage with overdose or excess
alcohol use
° worsening of existing liver disease ° kidney or liver damage with long-term use
° weak evidence of an interaction with warfarin.
If you take warfarin talk with your doctor about taking paracetamol.
NSAIDs – over-the-counter
diclofenac ibuprofen naproxen
° stomach problems including ulcers; risk is further increased when used with warfarin
° worsening of existing stomach problems
° increased risk of high blood pressure, heart
attacks or strokes
° gas, heartburn, nausea or diarrhoea ° headache or dizziness
° excess bleeding from wounds
° drug allergy ° skin rashes
° kidney damage (more likely in people with kidney problems or high blood pressure and in people who take both blood pressure and heart medications)
° occasional liver damage. NSAIDs – prescription celecoxib diclofenac etoricoxib ibuprofen indomethacin ketoprofen meloxicam naproxen parecoxib piroxicam sulindac tiaprofenic acid P A IN M E DICA T IONS
Common pain relievers and possible side effects Continued from page 25
ARTH ROSCO PIC SU RG ERY
A R T H R O S C O P I C
S U R G E R Y
A R T H R O S CO P I C S U R G E RY FO R A TO R N M E N I S C U S In this chapter:° What happens in arthroscopic surgery?
° Comparing arthroscopic surgery and exercise
° Arthroscopic surgery for a torn meniscus
won’t help arthritis symptoms
° The benefits of arthroscopic surgery for a
knee that catches are not known What happens in arthroscopic surgery? During arthroscopic surgery for a torn meniscus, a surgeon removes the torn and damaged parts of the meniscus, leaving as much of the meniscus in the knee as possible. This procedure is called a partial meniscectomy. To do arthroscopic surgery, the surgeon makes three small incisions around the knee joint. In one incision, the surgeon inserts a video camera about the size of a pencil. The camera shows the inside of the knee on a TV screen. The surgeon inserts surgical tools into the other two incisions. These tools are used to remove part of the meniscus. The surgery typically takes an hour or less, and people usually go home the same day. Arthroscopic surgery is also called arthroscopy.
Comparing arthroscopic surgery and exercise
If a torn meniscus seems to be causing your pain, can arthroscopic surgery plus knee exercises help more than knee exercises alone? The answer is unclear. The benefits of arthroscopic surgery for a torn meniscus are uncertain for people 40 and older. More research is needed to get final answers. Until those studies are done, doctors may disagree on which treatment is better. The results of one small study are provided next.
A study compared arthroscopic surgery and exercise therapy for meniscus tears
A well-designed, small study looked at 90 middle-aged people with meniscus tears. The people were divided into two groups. In each group, people had a range of osteoarthritis on x-rays from none to mild.
° One group did knee exercises two times a week.
° The other group had arthroscopic surgery
to remove the torn parts of the meniscus. After having surgery, this group also did knee exercises.
After six months, both groups got better. There was no difference in the amount of pain they felt or how well they could do physical activities.
There’s always a possibility that surgery won’t work. In this case, I had a very favourable outcome …
I’m virtually pain free.
Steve, had arthroscopic surgery followed by exercise
I wanted to do exercise rather than go directly to surgery. The pain is gone. It comes and goes at different times, but it’s changed completely.
ART H RO SC O P IC SU RG E R Y
In this study, arthroscopic surgery followed by knee exercises did not help relieve knee pain more than exercises alone. Although this study was well done, it was too small to give definite answers.
Comparing the benefits
The chart below compares people who had arthroscopic surgery followed by exercise, with people who did exercise alone.
During the six months of the study, people were asked to rate their pain. The chart shows that both groups had the same improvement in pain. Six months after treatment, the average pain rating for each group was less than “mild pain”. Arthroscopic surgery for a torn meniscus may not help more than excercise
Six months after treatment, the average amount of pain people felt was the same with or without arthroscopic surgery. Their pain level was less than “mild pain”.
Arthroscopic surgery for a torn meniscus won’t help arthritis symptoms
If you have arthritis but your symptoms seem to be from a torn meniscus, you can consider arthroscopic surgery to remove the torn part of the meniscus.
If you’re considering arthroscopic surgery, keep these two facts in mind:
° experts agree that arthroscopic surgery
will not help arthritis symptoms
° if arthroscopic surgery helps your
meniscus pain, you may still have knee problems from arthritis.
When you look at the chart, keep these things in mind:
° The chart shows the average results for
each group of people. An individual could have better or worse results than the average results shown in the chart.
° Most people in both groups got better. No one had worse pain after surgery or exercise.
° More research is needed to find out for
certain whether arthroscopic surgery can help pain from a torn meniscus more than exercise alone in people who are middle aged or older.
You may wonder if arthroscopic surgery to remove the torn parts of the meniscus could make arthritis pain worse in the future. Experts don’t know the answer to this question.
After I had the first surgery, I realised that the improvement was not what I expected. I did do a second surgery. The pain comes and goes.
ARTH ROSCO PIC SU RG ERY
The benefits of arthroscopic surgery for a knee that catches are not known
Many doctors believe that arthroscopic surgery can help a knee that catches. They believe that removing torn or loose pieces of meniscus that get in the way of normal knee movement can help this problem.
Experts have not done well-designed studies to find out if arthroscopic surgery helps when a torn meniscus seems to cause catching in the knee. So, there’s no good evidence that surgery is better than nonsurgical treatments for this type of problem. Sometimes catching symptoms get better with time, and some people get better with exercise.
A knee that catches is different from a knee that locks and requires effort to get it moving again. Surgery may be needed for a knee that locks.
R I S K S A N D R ECOV E RY A F T E R A R T H R O S CO P I C S U R G E RY In this chapter:
° Arthroscopic surgery is generally safe ° Recovery can take weeks to months
° Exercises are an important part of your recovery
Arthroscopic surgery is generally safe Fewer than two out of 100 people will have a complication after arthroscopic surgery. Serious complications include:
° infection
° a blood clot in the leg ° damage to the knee joint ° problems from anaesthesia.
More than 98 out of 100 people will not have any complications.
Your chance of having problems from surgery may depend on your overall health. Talk with your doctor about your risks and any concerns you have.
Recovery can take weeks to months After arthroscopic surgery, most people can expect:
° to go home the same day
° to put weight on the leg immediately after
surgery (some people may need to use crutches or a stick for a few days or weeks)
° to use pain medication (some people use
medication for the first few weeks, and others need it for less time).
Several weeks after surgery, most people are able to walk normally without a limp. Within a few weeks or months after surgery, many people are able to return to their normal activities. Your doctor will tell you when it’s okay to drive again.
If you have painful arthritis that limits your ability to do daily activities, your recovery may take longer.
Exercises are an important part of your recovery
Doctors sometimes recommend exercise after arthroscopic surgery to help your knee heal and get strong.
Even if you choose surgery, you may still need to exercise your knee to get better.
It’s likely that if you have been having problems with your knee for a long time … your recovery will be longer. Other factors that may influence your outcome are whether you have other illnesses, such as heart disease or diabetes.
Dr John Wright
The exercise that I did consisted of resistance bands, aerobic steps, and mainly a lot of stretching. After six weeks, I was able to do it on my own. So that went for another six weeks, which was very helpful in my recovery.
ART H RO SC O P IC SU RG E R Y
MAKING YOU R DECISIO N
In this chapter:
° What should you ask your doctor?
° How do you feel about surgery and
recovery when the chance of improvement is uncertain?
° How would you manage your symptoms
without surgery?
What treatment do you want to try for your knee symptoms? To decide what’s right for you, talk with your doctor about the most likely cause of your symptoms and how different treatments may help. This chapter includes some questions that may help you make your decision.
What should you ask your doctor?
If a doctor thinks a meniscus tear is causing your pain, be sure to ask:
° Why do you think my pain is from a
torn meniscus?
A meniscus tear that shows on an MRI may not be the cause of your symptoms. A doctor will consider your symptoms and the results of your knee exam, x-rays or MRIs to look for the most likely cause of pain.
° What else could be making my knee hurt? It’s not possible to know for certain that a torn meniscus is causing your symptoms. Other knee conditions, including arthritis, can cause symptoms that are a lot like a painful meniscus tear.
° Could my symptoms get better with exercise?
Exercises to strengthen the muscles around the knee and to improve the ability to move the joint can help many types of knee problems.
° Could arthroscopic surgery help me?
Medical experts don’t know if arthroscopic surgery to remove torn parts of the meniscus can help more than exercises in people 40 and older. Arthroscopic surgery will not help arthritis pain.
Do your homework. See what’s out there. Because surgery is not always the answer to the problem.
Beryl
If your doctor recommends arthroscopic surgery for your torn meniscus, make sure you know why your doctor thinks it can help you.
M A K I N G YO U R
MAKI N G Y O U R D E CISIO N
How do you feel about surgery and recovery when the chance of improvement is uncertain?
You’re the only person who can answer this question.
Arthroscopic surgery is generally safe, but there are risks, and you need time to recover. It may help to think about these questions:
° How much is your knee pain affecting your life? Is it bothering you so much that the chance of getting some pain relief is worth having a surgery that might not relieve all your pain?
° How worried are you about having a
complication from surgery?
° How long can you be away from work or
other responsibilities?
° How will you manage daily activities
during your recovery if walking is difficult?
How would you manage your symptoms without surgery?
Exercise takes time, and pain medications can have side effects. What are you willing to try? What makes sense in your life? As you consider your options, remember that surgery isn’t a way to avoid exercise. People who have arthroscopic surgery for a torn meniscus often do knee exercises during recovery. And many people continue exercising to manage symptoms they may have after surgery.
If I hadn’t had the surgery and I was still in pain, I would always be second guessing myself.
DEFIN ITIO NS O F M EDIC AL TER MS
Active ingredient: The active ingredient is
the name of the chemical in the medicine that makes it work. The manufacturer of the medicine also gives it another name—the brand name. There are often many brand names given to a single medicine; however, medicines with the same active ingredient are usually interchangeable.
Arthritis: The term often used for
osteoarthritis, the most common type of arthritis. In knee arthritis, the cartilage on the bones wears away and becomes rough. Bone spurs form as the body tries to make up for this damage. The meniscus may tear or completely wear away over time. Arthroscopic surgery [ar-thro-SKOP-ik]: A type of surgery done with three small incisions. A tiny camera is put into the knee to show the joint on a TV monitor. For people 40 and over with a torn meniscus, arthroscopic surgery is used to remove torn and damaged parts of the meniscus, leaving as much of the meniscus in the knee as possible.
Bone spur: A growth on the side of a bone
that is often a sign of arthritis.
Cartilage [KARTL-ij]: A firm, smooth
material that allows the bones of a joint to slide smoothly against one another.
Drug interaction: A situation when another
drug, supplement, or food affects the way a drug works in the body, usually by making the drug too strong or too weak.
Exercise (for knee pain): A set of exercises
designed to strengthen muscles, increase how far the knee can bend and straighten, and improve balance and coordination.
Exercise physiologist: A health professional
who specialises in treating people
through exercise. You can find an exercise physiologist through Exercise and Sports Science Australia (ESSA) essa.org.au
Femur [FEE-mur]: The thighbone.
Meniscus [meh-NIS-kus]: The disc of tissue
between the bones of the knee that absorbs impact and helps distribute body weight across the entire knee.
MRI: Stands for magnetic resonance imaging. A way to take pictures of the organs and tissues inside the body. MRI uses a powerful magnet instead of radiation. Nonsteroidal anti-inflammatory drugs
(NSAIDs) [EN-seds]: Drugs such as aspirin,
ibuprofen, and naproxen, which reduce inflammation, pain, and swelling.
Orthopaedic surgeon [or-thuh-PEE-dik]: A surgeon with special training in surgery on bones, joints, and muscles.
Osteoarthritis [OS-tee-oh-ar-THRI-tis]: The most common type of arthritis. It includes the breakdown of the cartilage in a joint, often causing pain, stiffness, and limited motion. Often called arthritis. Partial meniscectomy [men-i-SKEK-tuh-mee]: A surgery that removes torn and damaged parts of the meniscus, leaving as much of the meniscus in the knee as possible.
Patella [PUH-tel-uh]: The kneecap.
Physiotherapist: A professional trained
to teach exercises to strengthen muscles, reduce stiffness, and increase range of motion.
Rheumatologist [roo-ma-TOL-uh-jist]: A
doctor who specialises in treating people who have arthritis and related diseases.
Sports medicine physician: A doctor who
specialises in treating injury and disease with physical methods, like exercise.
D E F IN IT IO N S O F M E D IC A L T E R M S A N D FO R M O R E I N FO R M A T IO N
FO R M O R E I N FO R MATIO N
Agency for Healthcare Research and Quality The Agency for Healthcare Research and Quality provides a consumer guide to choosing pain medications for osteoarthritis. effectivehealthcare.ahrq.gov
Arthritis Australia
The Arthritis Australia website has a series of information sheets and brochures covering different forms of arthritis and different treatment options. Click through to your state organisation to access self-management courses.
arthritisaustralia.com.au
Australian Orthopaedic Association The Australian Orthopaedic Association website has a tool to help you find an orthopaedic surgeon and links to comprehensive patient information. aoa.org.au
Australian Physiotherapy Association The Australian Physiotherapy Association website contains a tools to help you find a physiotherapist, links to a database of evidence for physiotherapy as well as relevant information about physiotherapy and what to expect.
physiotherapy.asn.au
Australian Rheumatology Association The Australian Rheumatology Association website has a series of patient information sheets covering a number of categories— “Your condition explained” and “Managing your condition”. There is also a tool to help you find a rheumatologist.
rheumatology.org.au
National Prescribing Service (NPS)
NPS provides practical tools and information about medicines used to treat arthritis. The NPS Medicine Name Finder can help you learn to identify your prescription medicines by the active ingredient name and brand name. nps.org.au
