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Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: 5-year follow-up
  1. Jyrki A Kettunen1,2,
  2. Arsi Harilainen2,
  3. Jerker Sandelin2,
  4. Dietrich Schlenzka2,
  5. Kalevi Hietaniemi3,
  6. Seppo Seitsalo2,
  7. Antti Malmivaara4,
  8. Urho M Kujala5
  1. 1Arcada University of Applied Sciences, Jan-Magnus Janssonin aukio 1, Helsinki, Finland
  2. 2The ORTON Orthopaedic Hospital, ORTON Foundation, Helsinki, Finland
  3. 3The Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland
  4. 4Centre for Health and Social Economics, CHESS, National Institute for Health and Welfare, Helsinki, Finland
  5. 5The Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
  1. Correspondence toDr Jyrki A Kettunen, Arcada University of Applied Sciences, Jan-Magnus Janssonin aukio 1, FIN-00550 Helsinki, Finland; jyrki.kettunen{at}


Objective To study the long-term outcome of arthroscopy in patients with chronic patellofemoral pain syndrome (PFPS), the authors conducted a randomised controlled trial. The authors also investigated factors predicting the outcome in patients with PFPS.

Methods Fifty-six patients with PFPS were randomised into two groups: an arthroscopy group (N=28), treated with knee arthroscopy and an 8-week home exercise programme, and a control group (N=28), treated with a similar 8-week home exercise programme only. The primary outcome was the Kujala score on pain and function at 5-year. Secondary outcomes were visual analogue scales (VASs) to assess activity-related symptoms.

Results According to the Kujala score, both groups showed a marked improvement during the 5-year follow-up: a mean improvement of 14.7 (95% CI 9.9 to 19.4) in the arthroscopy group and 13.5 (95% CI 8.1 to 18.8) in the controls. No differences between the groups in mean improvement in the Kujala score (group difference 1.2 (95% CI –8.4 to 6.1)) or in the VAS scores were found. None of the investigated factors predicted the long-term outcome, but in most of the cases the treatment result immediately after the exercise programme remained similar also after the 5-year follow-up.

Conclusion Our RCT, being the first of its kind, indicates that the 5-year outcome in most of the patients with chronic PFPS treated with knee arthroscopy and home exercise programme or with the home exercise programme only is equally good in both groups. Some of the patients in both groups do have long-term symptoms.

Trial registration Current Controlled Trials ISRCTN 41800323.

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  • Funding Supported by a grant from The Social Insurance Institution of Finland.

  • Competing interests None.

  • Ethical approval Ethics approval was provided by the Hospital District of Helsinki and Uusimaa and the review board of the ORTON Orthopaedic Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.