A new study has reported that exercise therapy is as effective as surgery for middle aged patients degenerative meniscal tear.
Menisici are the rubbery cushion in the knee joint.
The study has been published in The BMJ this week.
The researchers suggest that supervised exercise therapy should be considered as a treatment option for middle aged patients with meniscal tear.
About 300 in 100,000 people undergo arthroscopic partial meniscectomy in Western world with some countries reporting doubling of surgery rate in 10 years from 2000 to 2011 with three out of four patients aged more than 35 years, an age group where most meniscal tears are degenerative.
Study is Randomized Control Trial
The study is a randomized controlled trial carried jointly by Denmark and Norway researchers. The question was to find out if exercise therapy alone compares with arthroscopic surgery alone in middle aged patients with degenerative meniscal tears.
A randomized controlled trial is a type of study where participants are randomly assigned to one of the two groups. One group served as control for the other. Randomized control trial is one of the best ways for determining whether an intervention actually is effective.
They identified 140 adults) with non-traumatic degenerative meniscal tears, verified by MRI scan. The average age was 50 years at two public hospitals and two physiotherapy clinics in Norway. Following inculsion critieria was chosen.
Between October 2009 and September 2012, we recruited participants
- Inclusion criteria were age 35-60 year
- Unilateral knee pain for more than two months without a major traum
- Medial degenerative meniscal tear verified by magnetic resonance imaging
- At most, radiographic changes equivalent to grade 2 according to the Kellgren-Lawrence classification.
Almost all (96%) participants had no definitive x-ray evidence of osteoarthritis.
Half of the patients received a supervised exercise program 2-3 sessions each week for 12 weeks and half received arthroscopic surgery followed by simple daily exercises to perform at home.
Thigh muscle strength was assessed at three months and patient reported knee function was recorded at two years.
The study authors found that there is no clinically relevant difference was between the two groups for outcomes such as pain, function in sport and recreation, and knee related quality of life.
Thirteen (19%) of participants in the exercise group crossed over to surgery during the follow-up period, with no additional benefit.
The authors recommended that middle aged patients with degenerative meniscal tear and no radiographic evidence of osteoarthritis should be considered for supervised structured exercise therapy as a treatment option.
- Nina Jullum Kise, May Arna Risberg, Silje Stensrud, Jonas Ranstam, Lars Engebretsen, Ewa M Roos. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ, 2016; i3740 DOI: 10.1136/bmj.i3740
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