Exercise therapy is as effective as surgery for middle-aged patients with a meniscal tear, finds a study in The BMJ.
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, an estimated two million people worldwide undergo knee arthroscopy at a cost of several billion US dollars. Yet current evidence suggests that arthroscopic knee surgery offers little benefit for most patients.
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.
The research team identified 140 adults (average age 50 years) with degenerative meniscal tears, verified by MRI scan, at two public hospitals and two physiotherapy clinics in Norway. Almost all (96 per cent) participants had no definitive X-ray evidence of osteoarthritis.
Half of the patients received a supervised exercise programme over 12 weeks (two to three sessions each week) 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.
No clinically relevant difference was found between the two groups for outcomes such as pain, function in sport and recreation, and knee-related quality of life. At three months, muscle strength had improved in the exercise group.
No serious adverse events occurred in either group during the two-year follow-up. Thirteen (19 per cent) of the 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,” 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.”
Reference: Kise, N.J., Risberg, M.A., Stensrud, S., et al. 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