Exercise appears as effective as surgery for middle-aged patients with meniscal tear
At 3 months, muscle strength had improved more in the exercise group than in the surgery group, and there was no clinically relevant difference in knee pain, other symptoms, function in sport and recreation, and knee-related quality of life, researchers found.
Exercise therapy is as effective as surgery for middle-aged patients with a meniscal tear, a study found.
Researchers based in Denmark and Norway conducted a randomized, controlled trial to compare exercise therapy alone to arthroscopic surgery alone in 140 adults who were an average of 50 years old and with degenerative meniscal tears, verified by MRI scan, at 2 public hospitals and 2 physiotherapy clinics in Norway. Almost all patients (96%) had no X-ray evidence of osteoarthritis.
Half of the patients undertook a supervised exercise program of 2 to 3 sessions per week for 12 weeks, and half received arthroscopic surgery followed by simple daily exercises to perform at home. Thigh muscle strength was assessed at 3 months and patient-reported knee function was recorded at 2 years. Researchers also assessed a knee injury and osteoarthritis outcome score (KOOS4), which measured pain, other symptoms, function in sport and recreation, and knee-related quality of life.
Results were published online July 20 by The BMJ.
No clinically relevant difference was found between the 2 groups in change in KOOS4 at 2 years (0.9 points; 95% CI, −4.3 to 6.1; P=0.72). At 3 months, muscle strength had improved more in the exercise group than in the surgery group (P≤0.004). No serious adverse events occurred in either group during the 2-year follow-up. Thirteen participants in the exercise group (19%) crossed over to surgery during the follow-up period, with no additional benefit observed.
Supervised exercise therapy should be considered as a treatment option for middle-aged patients with this type of knee damage, the authors noted. “Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term,” said the authors. “Our results should encourage clinicians and middle-aged patients with degenerative meniscal tear and no radiographic evidence of osteoarthritis to consider supervised structured exercise therapy as a treatment option.”
An editorial noted that the orthopedic community may be dismissive of studies that counter the conventional wisdom of surgery, “preferring to argue that the trials do not reflect the real world: they are ‘explanatory’ or ‘mechanistic’ trials, instead of being ‘pragmatic’ or ‘practical’.”
However, the editorial stated, “In a world of increasing awareness of constrained resources and epidemic medical waste, what we should not do is allow the orthopedic community, hospital administrators, health care providers, and funders to ignore the results of rigorous trials and continue widespread use of procedures for which there has never been compelling evidence.”