Meniscus surgery or exercise?

skaermbillede-2016-12-26-kl-15-59-15Meniscus surgery

or exercise?

skaermbillede-2016-12-26-kl-14-58-10Surgery compare to rehabilitation (2007) “Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial”  concluded that arthroscopic partial medial meniscectomy followed by supervised exercise was not superior to supervised exercise alone in terms of reduced knee pain, improved knee function and improved quality of life.

Same result was concluded from a RCT two year follow up “Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients – RCT with 2 follow-up, 2016” where Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. The results should encourage clinicians and middle aged patients with degenerative meniscal tear and with no definitive radiographic evidence of OA to consider supervised exercise therapy as a treatment option.

Again a third study “Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up” found no difference in arthroscopic + exercise versus exercise alone. Draw your attention to the conclusion “The findings indicate that arthroscopic surgery followed by exercise therapy was not superior to the same exercise therapy alone for this type of patients“.

Finally, a study from 2013 concluded “Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis” that the in intention-to-treat analysis, did not find significant differences between the study groups in functional improvement 6 months after randomization; however, 30% of the patients who were assigned to physical therapy alone underwent surgery within 6 months.

The Take Home Message from these four studies is that Rehabilitation is the primary intervention for degenerative meniscus tear. This can have individual benefit as well as economic benefit for the health care system. Keep the meniscus in the knee as long as indicated and do not treat the OA-imaging but patient.

  1. Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, m.fl. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 26. december 2013;369(26):2515–24.
  2. Herrlin S, Hållander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. april 2007;15(4):393–401.
  3. Herrlin SV, Wange PO, Lapidus G, Hållander M, Werner S, Weidenhielm L. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc. februar 2013;21(2):358–64.
  4. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, m.fl. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. N Engl J Med. 2. maj 2013;368(18):1675–84.

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