PURPOSE: The aim of this prospective randomized intervention study was to evaluate the outcome at a 2 and 5 year follow-up whether combined arthroscopic surgery followed by exercise therapy was superior to the same exercise therapy alone when treating non-traumatic, degenerative medial meniscal tears. METHODS:Ninety-six middle-aged patients with MRI-verified degenerative medial meniscus tear and radiographic osteoarthritis grade ≤1 (Ahlbäck) participated in the study. Radiographic examination was done before randomization and after 5 years. The patients were randomly assigned to either arthroscopic treatment followed by exercise therapy for 2 months or to the same exercise therapy alone. At the start of the study and at the follow-ups at 24 and 60 months the patients answered three questionnaires KOOS, Lysholm Knee Scoring Scale and Tegner Activity Scale and made pain ratings on the Visual Analogue Scale (VAS). RESULTS: Both groups showed highly significant clinical improvements from baseline to the follow-ups at 24 and 60 months on all subscales of KOOS, Lysholm Knee Scoring Scale and VAS (p < 0.0001). No group differences were found at any of the testing occasions. One third of the patients that were treated with exercise therapy alone did not feel better after the treatment but were improved after arthroscopic surgery. According to radiographic findings two patients from each group had a slight progression of their osteoarthritis after 5 years. 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. Consequently, exercise therapy can be recommended as initial treatment. However, one third of the patients from the exercise group still had disabling knee symptoms after exercise therapy but improved to the same level as the rest of the patients after arthroscopic surgery with partial meniscectomy. LEVEL OF EVIDENCE: I.
RCT Entities:
PURPOSE: The aim of this prospective randomized intervention study was to evaluate the outcome at a 2 and 5 year follow-up whether combined arthroscopic surgery followed by exercise therapy was superior to the same exercise therapy alone when treating non-traumatic, degenerative medial meniscal tears. METHODS: Ninety-six middle-aged patients with MRI-verified degenerative medial meniscus tear and radiographic osteoarthritis grade ≤1 (Ahlbäck) participated in the study. Radiographic examination was done before randomization and after 5 years. The patients were randomly assigned to either arthroscopic treatment followed by exercise therapy for 2 months or to the same exercise therapy alone. At the start of the study and at the follow-ups at 24 and 60 months the patients answered three questionnaires KOOS, Lysholm Knee Scoring Scale and Tegner Activity Scale and made pain ratings on the Visual Analogue Scale (VAS). RESULTS: Both groups showed highly significant clinical improvements from baseline to the follow-ups at 24 and 60 months on all subscales of KOOS, Lysholm Knee Scoring Scale and VAS (p < 0.0001). No group differences were found at any of the testing occasions. One third of the patients that were treated with exercise therapy alone did not feel better after the treatment but were improved after arthroscopic surgery. According to radiographic findings two patients from each group had a slight progression of their osteoarthritis after 5 years. 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. Consequently, exercise therapy can be recommended as initial treatment. However, one third of the patients from the exercise group still had disabling knee symptoms after exercise therapy but improved to the same level as the rest of the patients after arthroscopic surgery with partial meniscectomy. LEVEL OF EVIDENCE: I.
Authors: Timothy Bhattacharyya; Daniel Gale; Peter Dewire; Saara Totterman; M Elon Gale; Sara McLaughlin; Thomas A Einhorn; David T Felson Journal: J Bone Joint Surg Am Date: 2003-01 Impact factor: 5.284
Authors: Alexandra Kirkley; Trevor B Birmingham; Robert B Litchfield; J Robert Giffin; Kevin R Willits; Cindy J Wong; Brian G Feagan; Allan Donner; Sharon H Griffin; Linda M D'Ascanio; Janet E Pope; Peter J Fowler Journal: N Engl J Med Date: 2008-09-11 Impact factor: 91.245
Authors: J Bruce Moseley; Kimberly O'Malley; Nancy J Petersen; Terri J Menke; Baruch A Brody; David H Kuykendall; John C Hollingsworth; Carol M Ashton; Nelda P Wray Journal: N Engl J Med Date: 2002-07-11 Impact factor: 91.245
Authors: Jeffrey N Katz; Savannah R Smith; Heidi Y Yang; Scott D Martin; John Wright; Laurel A Donnell-Fink; Elena Losina Journal: Arthritis Care Res (Hoboken) Date: 2017-03-03 Impact factor: 4.794
Authors: Jamie E Collins; Elena Losina; Robert G Marx; Ali Guermazi; Mohamed Jarraya; Morgan H Jones; Bruce A Levy; Lisa A Mandl; Scott D Martin; Rick W Wright; Kurt P Spindler; Jeffrey N Katz Journal: Arthritis Care Res (Hoboken) Date: 2020-05 Impact factor: 4.794
Authors: Jeffrey N Katz; Swastina Shrestha; Elena Losina; Morgan H Jones; Robert G Marx; Lisa A Mandl; Bruce A Levy; Lindsey A MacFarlane; Kurt P Spindler; Genevieve S Silva; Jamie E Collins Journal: Arthritis Rheumatol Date: 2019-12-15 Impact factor: 10.995
Authors: R Seil; Jon Karlsson; P Beaufils; R Becker; S Kopf; M Ollivier; M Denti Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-02 Impact factor: 4.342
Authors: Victor A van de Graaf; Julia C A Noorduyn; Nienke W Willigenburg; Ise K Butter; Arthur de Gast; Ben W Mol; Daniel B F Saris; Jos W R Twisk; Rudolf W Poolman Journal: JAMA Date: 2018-10-02 Impact factor: 56.272