Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up
- Nina Jullum Kise1,
- May Arna Risberg2,3,4,
- Silje Stensrud2,
- Jonas Ranstam5,
- Lars Engebretsen3,6,7,
- Ewa M Roos8
- 1Department of Orthopaedic Surgery, Martina Hansens Hospital, PO box 823, N-1306 Sandvika, Norway
- 2Norwegian Research Centre for Active Rehabilitation, Oslo, Norway
- 3Division of Orthopaedic Surgery, Oslo University Hospital, Norway
- 4Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- 5Department of Orthopaedics, Clinical Sciences Lund, Lund University, Sweden
- 6Faculty of Medicine, University in Oslo
- 7Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
- 8Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Correspondence to N J Kise,
- Accepted 26 June 2016
Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears.
Design Randomised controlled superiority trial.
Setting Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway.
Participants 140 adults, mean age 49.5 years (range 35.7–59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis.
Interventions 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone.
Main outcome measures Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months.
Results No clinically relevant difference was found between the two groups in change in KOOS4 at two years (0.9 points, 95% confidence interval −4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit.
Conclusion The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.
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