Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: Results of a randomized controlled study

doi:10.1016/0003-9993(94)90165-1

Archives of Physical Medicine and Rehabilitation

Volume 75, Issue 4, April 1994, Pages 415-426

https://doi.org/10.1016/0003-9993(94)90165-1 Get rights and content

Abstract

The efficacy of an early, intensive, supervised rehabilitation program to accelerate knee strength recovery in the first 3 weeks postmeniscectomy by arthroscopy was evaluated using a randomized controlled trial design. The maximal voluntary isokinetic strength of 31 men, randomly allocated to either a treatment (EXP) or a control (CTL) group, was measured twice by a blind rater: preoperatively (pretest) and 3 weeks postsurgery (posttest), using a computer-controlled Kin-Com dynamometer (Chattecx Corporation, Chattanooga, TN). Strength deficits of the operated leg at the pretest and posttest were established in percent of the values obtained for the sound leg at the pretest. In the interval between the surgery and the posttest, the patients of the EXP group (n = 15) received nine supervised treatments combined to home exercises whereas patients of the control group (n = 16) had no specific physiotherapy treatment but were given instructions in postsurgical management and prescribed exercises by the orthopedic surgeons. Patients of the EXP group had better knee extensor strength recovery than patients of the CTL group (ANCOVA, p < 0.001). The size of the strength difference (3 weeks postsurgery) between EXP and CTL subgroups (n = 8) matched according to preoperative dificits was as large as 26% and the residual deficits of the untreated patients were two to three times larger than those of the treated patients. The results of this study highlight the importance of instituting an early intensive and supervised rehabilitation program, especially for workers returning to a strenuous job requiring good knee extensor muscle function.

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Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to summarise the outcomes following treatment with a meniscal tear and explore correlations between outcomes.
A systematic review was performed of MEDLINE, EMBASE, AMED and the Cochrane Central Register of Controlled Trials to identify prospective studies describing the outcomes of patients with a meniscal tear. Comparisons were made of outcomes between APM and non-operative groups. Outcomes were graphically presented over time for all treatment interventions. Pearson’s correlations were calculated between outcome timepoints.
35 studies were included, 28 reported outcomes following APM; four following meniscal repair and three following meniscal transplant. Graphical plots demonstrated a sustained improvement for all treatment interventions. A moderate to very strong correlation was reported between baseline and three-month outcomes. In the medium term, there was small significant difference in outcome between APM and non-operative measures (SMD 0.17; 95 % CI 0.04, 0.29), however, this was not clinically significant.
Patients with a meniscal tear demonstrated a sustained initial improvement in function scores, which was true of all treatments examined. APM may have little benefit in older people, however, previous trials did not include patients who meet the current indications for surgery as a result the findings should not be generalised to all patients with a meniscal tear. Further trials are required in patients who meet current operative indications.
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To compare the effects of conventional (constant load) eccentric training and isokinetic eccentric training on quadriceps muscle mass, strength and functionality of recreational athletes following partial meniscectomy.
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32 recreational male athletes (∼27 years old) who underwent partial meniscectomy performed a 6-week quadriceps strength training program in one of the experimental groups: conventional group (CG) or icokinetic group (IG).
Quadriceps muscle mass, strength, and patients’ objective and self-reported function.
Both groups enhanced muscle mass, strength and functionality outcomes. The IG presented higher increases than CG for muscle mass (ES = 0.99–1.41), strength (ES = 1.48–2.35), and Lysholm score (ES = 1.0). The magnitude-based inference supports that results ‘very likely’ or ‘almost certainly’ favour IG compared to CG for all outcomes, except for the single leg hop test (i.e., between-group similar change).
After partial meniscectomy, isokinetic eccentric training is more effective than conventional eccentric training to restore quadriceps muscle mass, strength, and functional capacity.
Demographics and rates of surgical arthroscopy and postoperative rehabilitative preferences of arthroscopists from the Arthroscopy Association of North America (AANA)
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Survey of 869 arthroscopists regarding joint-specific arthroscopic procedures and postoperative rehabilitative preferences revealed comparable support for use of supervised physical therapy (SPT) and home exercise programs (HEPs) but stronger preference for joint-specific HEP applications (wrist, knee). Among respondents utilizing HEPs, modality of delivery (verbal/handout/web-based) didn’t differ by joint, yet only 2.9% utilized web-based HEPs. This is the first known study to identify postoperative rehabilitation preferences. With 1.77 million estimated arthroscopic procedures annually (mean: 325.4 procedures/respondent), this study highlights under-utilization of web-based HEPs. Reliable, web-based HEPs can improve post-arthroscopic outcomes for patients, arthroscopic surgeons, and rehabilitative specialists while being cost efficient.
Effectiveness of exercise therapy for meniscal lesions in adults: A systematic review and meta-analysis
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Citation Excerpt :
The interobserver reliability of the eligibility assessment of the articles was good (κ 0.71). Of the 14 articles originally included,9–22 the results of one study were described in three separate articles15,16,18 leading to 12 unique studies. Table 1 presents the characteristics of the included studies.
This study evaluated the effectiveness of exercise therapy in patients with meniscal lesions.
Systematic review and meta-analysis.
Nine databases were searched up to July 2015, including EMBASE and Medline OvidSP. Randomized and controlled clinical trials in adults with traumatic or degenerative meniscal lesions were considered for inclusion. Interventions had to consist of exercise therapy in non-surgical patients or after meniscectomy, and had to be compared with meniscectomy, no exercise therapy, or to a different type of exercise therapy. Primary outcomes were pain and function on short term (≤3 months) and long term (>3 months). Two researchers independently selected the studies, assessed the risk of bias, and extracted data.
Of the 1415 identified articles 14 articles describing 12 studies were included; all had some concerns about the risk of bias. There was no significant difference between exercise therapy and meniscectomy for pain (MD 0.27 [−4.30,4.83]) and function (SMD −0.32 [−0.68,0.03]). After meniscectomy, there was conflicting evidence for the effectiveness of exercise therapy when compared to no exercise therapy for pain and function. There was no significant difference between various types of exercise therapy for pain (MD 19.30 [−6.60,45.20]) and function (SMD 0.01 [−0.27,0.28]).
Exercise therapy and meniscectomy yielded comparable results on pain and function. Exercise therapy compared to no exercise therapy after meniscectomy showed conflicting evidence at short term, but was more effective on function at long term. The preferable type/frequency/intensity of exercise therapy remains unclear. The strength of the evidence was low to very low.
Disability, impairment, and physical therapy utilization after arthroscopic partial meniscectomy in patients receiving workers' compensation
2012, Journal of Bone and Joint Surgery
Citation Excerpt :
Providing more services does not necessarily ensure better results and may have either no effect or a negative effect on functional or financial outcomes. Some investigators have found that supervised physical therapy is essential to successful functional outcomes following partial meniscectomy19–21, whereas others have demonstrated that unsupervised home rehabilitation produced equally good functional outcomes with a substantial reduction in medical costs when compared with supervised physical therapy22,23. Studies in Texas demonstrated a wide variation in the provision of physical medicine services to patients receiving Workers’ Compensation within that state, with high-volume providers utilizing over six times the median number of visits for therapeutic exercise24,25.
The treatment of meniscal tears in injured workers is associated with less favorable outcomes and higher utilization of clinical services. It was hypothesized that patients receiving Workers’ Compensation who undergo arthroscopic meniscectomy can have excellent outcomes with physical therapy utilization below the national best-practices benchmarks.
The records of 155 injured workers who had undergone 164 primary arthroscopic meniscectomies were reviewed at least one year following claim closure. The time to release to unrestricted full work duty and the number of postoperative physical therapy visits were compared between the study group (managed with a protocol-driven, independent exercise program) and the control group (managed with traditional outpatient physical therapy). The traditional therapy regimen was implemented by means of a written referral stating general goals (knee range of motion, strength, and function) and recommending a range or a maximum number of visits to be attended. Patients in the study group received a written referral specifying the exact number of visits that were approved, a kit containing exercise equipment with a booklet illustrating twenty-five exercises, and a prescribed rehabilitation protocol outlining the philosophy, expected subjective and functional outcomes, and specific objective weekly goals.
The median number of physical therapy visits per patient was 40% lower in the study group than in the control group (six compared with ten; p < 0.001). There was no difference between the study group and the control group with regard to the permanent partial disability rate (0% compared with 4.3%; p = 0.076). Following arthroscopic meniscectomy, there was no significant difference between the study group and the control group in terms of the time to release to light duty, the time to release to full duty, the time to claim closure, or the rate of impairment.
The implementation of a structured, independent exercise protocol appears promising as a method to reduce physical therapy utilization to levels below the national best-practices benchmarks without negatively impacting impairment and disability rates for patients receiving Workers’ Compensation who undergo arthroscopic meniscectomy.
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^☆: This research supported by grants from the Fonds de la Recherche en Santé du Québec (FRSQ) and the Foundation de l'Hôpital de l'Enfant-Jésus, Québec (QC), Canada. Hélène Moffet was the recipient of a doctoral studentship from the FRSQ.

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ArticleEarly and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: Results of a randomized controlled study☆

Abstract

Arthroscopy

Arthroscopy

Arthroscopy

J Biomech

Pain

Electroencephal Clin Neurophysiol

Early results of closed partial meniscectomy

Br Med J

Isokinetic and functional evaluation of the knee following arthroscopic surgery

Clin Orthop

The effect of diagnostic and operative arthroscopy and open meniscectomy on muscle strength in the thigh

Am J Sports Med

Arthroscopic meniscectomy: a follow-up report

Am J Sports Med

Closed versus open partial meniscectomy: postoperative changes in the force-velocity relationship of muscle

Am J Sports Med

Knee function after arthroscopic meniscectomy

Acta Orthop Scand

A comparison between arthroscopic meniscectomy and modified open meniscectomy

J Bone Joint Surg

The use of transcutaneous neural stimulation and isokinetic testing in arthroscopic knee surgery

Am J Sports Med

Partial arthroscopic meniscectomy versus total open meniscectomy

Arch Orthop Trauma Surg

Follow-up results of 3,500 arthroscopic operations on the knee joint

Surg Endosc

The results of partial arthroscopic meniscectomy in patients over 40 years of age

J Bone Joint Surg

Long-term results of arthroscopic partial meniscectomy

Clin Orthop

Arthroscopic, open partial, and total meniscectomy, a comparative study

J Bone Joint Surg

Closed partial meniscectomy. early results for simple tears with mechanical symptoms

J Bone Joint Surg

Results of arthroscopic meniscectomy

Ital J Orthop Traumatol

Strength recovery and muscle activation of the knee extensor and flexor muscles after arthroscopic meniscectomy

Clin Orthop

Motor recovery after arthroscopic partial meniscectomy: analyses of gait and the ascent and descent of stairs

J Bone Joint Surg [Am]

Strength recovery of the knee extensor and flexor muscles after meniscectomy by arthroscopy

Factors affecting the occurrence of knee injuries

JAPMR

Postsurgical knee rehabilitation

Am J Sports Med

Velocity spectrum rehabilitation with isokinetics. a protocol rationale for clinical knee rehabilitation

Clin Manag

Isokinetic rehabilitation after surgery. a review of factors which are important for developing physiotherapeutic techniques after knee surgery

Am J Sports Med

Knee rehabilitation following arthroscopic meniscectomy

Clin Orthop

Rehabilitation of the arthroscopic knee

Va Med

Improvements in rehabilitation of the postmeniscectomized or meniscal-repaired patient

Clin Orthop

Rehabilitation of the injured knee

Rehabilitation following knee surgery

Sports Med

Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale

Am J Sports Med

The knee

The knee

Neural adaptation to resistance training

Med Sci Sports Exerc

Increase of muscle strength from isometric quadriceps exercises at different knee angles

Scand J Rehab Med

Electromyography of the quadriceps femoris muscles in subjects with normal knees and acutely effused knees

Phys Ther

Article
Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: Results of a randomized controlled study☆