what does a torn meniscus look like
The researchers suggest that supervised exercise therapy should be considered as a treatment option for middle aged patients with this type of knee damage. Every year, 2 million people worldwide undergo knee arthroscopy (keyhole surgery to relieve pain and improve movement) at a cost of several billion US dollars. Yet current evidence suggests that arthroscopic knee surgery offers little benefit for most patients. So researchers based in Denmark and Norway carried out a randomised controlled trial to compare exercise therapy alone with arthroscopic surgery alone in middle aged patients with degenerative meniscal tears.
They identified 140 adults (average ~50 years) with degenerative meniscal tears, verified by MRI scan, at 2 public hospitals and 2 physiotherapy clinics in Norway. Almost all (96%) participants had no definitive x-ray evidence of osteoarthritis. Half of the patients received a supervised exercise program over 12 weeks (2-3 sessions each week) 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.
Lower extremity performance tests: one leg hop test (cm), 6 m timed hop test (sec), and number of knee bends in 30 seconds (n) at three and 12 months. Whiskers represent 95% confidence intervals
Results: No clinically relevant difference was found between the 2 groups for outcomes such as pain, function in sport and recreation, and knee related quality of life. At 3 months, muscle strength had improved in the exercise group. No serious adverse events occurred in either group during the 2-year follow-up. 13 (19%) of participants in the exercise group crossed over to surgery during the follow-up period, with no additional benefit.
“Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term,” say 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.”
“In a world of increasing awareness of constrained resources and epidemic medical waste, what we should not do is allow the orthopaedic community, hospital administrators, healthcare providers, and funders to ignore the results of rigorous trials and continue widespread use of procedures for which there has never been compelling evidence,” they conclude. http://www.eurekalert.org/pub_releases/2016-07/b-eae072016.php http://www.bmj.com/content/354/bmj.i3740
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