Advertisement

Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial

  • Sylvia Herrlin
  • Maria Hållander
  • Peter Wange
  • Lars Weidenhielm
  • Suzanne Werner
Knee

Abstract

In this prospective randomised study two treatments after non-traumatic medial meniscal tear diagnosed with radiological examination and magnetic resonance imaging were compared; arthroscopic partial meniscectomy followed by supervised exercise or supervised exercise alone. The aim was to evaluate knee function and physical activity. Ninety patients (mean age 56 years) were evaluated using the Knee Injury and Osteoarthritis Outcome Score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and a Visual Analogue Scale for knee pain prior to the intervention, after 8 weeks of exercise and after 6 months. According to the outcome scores arthroscopic partial medial meniscectomy combined with exercise did not lead to greater improvement than exercise alone. After the intervention both groups reported decreased knee pain, improved knee function and a high satisfaction (P < 0.0001). Forty-one per cent of the patients returned to their pre-injury activity level after 6 months. In conclusion, when evaluated with outcome scores, arthroscopic partial medial meniscectomy followed by supervised exercise was not superior to supervised exercise alone in terms of reduced knee pain, improved knee function and improved quality of life.

Keywords

Arthroscopy Knee Joint Exercise Physiotherapy Questionnaires 

References

  1. 1.
    Aagaard H, Verdonk R (1999) Function of the normal meniscus and consequences of meniscal resection. Scand J Med Sci Sports 9:134–140PubMedCrossRefGoogle Scholar
  2. 2.
    Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiologica 277(Suppl 277):7–72Google Scholar
  3. 3.
    Aichroth P (1996) Degenerative meniscal tears. Knee 3:70–72CrossRefGoogle Scholar
  4. 4.
    American College of Sports Medicine (ACSM) (2002) Progression models in resistance training for healthy adults. Med Sci Sports Exerc 34:364–380Google Scholar
  5. 5.
    Augustsson J (2001) Styrketräning vid rehabilitering. Sv Idr Forskn 3:65–71Google Scholar
  6. 6.
    Bengtsson J, Möllborg J, Werner S (1996) A study for testing the sensitivity and reliability of the Lysholm knee scoring scale. Knee Surg, Sports Traumatol, Arthrosc 4:27–31CrossRefGoogle Scholar
  7. 7.
    Bhattacharyya T et al (2003) The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Joint Surg Am 85:4–9PubMedGoogle Scholar
  8. 8.
    Burks RT, Metcalf MH, Metcalf RW (1997) Fifteen-year follow-up of arthroscopic partial meniscectomy. J Arthroscopic Rel Surg 13:673–679CrossRefGoogle Scholar
  9. 9.
    Börjesson M, Robertson E, Weidenhielm L, Mattsson E, Olsson E (1996) Physiotherapy in knee osteoarthrosis: effect on pain and walking. Physiother Res Int 1:89–97PubMedGoogle Scholar
  10. 10.
    Börjesson M, Karlsson J, Mannheimer C (2001) Mindre ont med motion. Läkartidningen 5:1786–1791Google Scholar
  11. 11.
    Cameron ML, Briggs KK, Steadman JR (2003) Reproducibility and reliability of the Outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 31:83–86PubMedGoogle Scholar
  12. 12.
    Chatain F, Robinson AH, Adeleine P, Chambat P, Neyret P (2001) The natural history of the knee following arthroscopic medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 9(1):15–18PubMedCrossRefGoogle Scholar
  13. 13.
    Desai VV, Ackroyd CE (2000) Resection of degenerate menisci—is it useful? Knee 7(3):179–182PubMedCrossRefGoogle Scholar
  14. 14.
    Englund M, Roos EM, Roos HP, Lohmander LS (2001) Patient-relevant outcomes fourteen years after menisectomy: influence of type of meniscal tear and size of resection. Rheumatology 40:631–639PubMedCrossRefGoogle Scholar
  15. 15.
    Feigenbaum M, Pollock M (1999) Prescription of resistance training for health and disease. Med Sci Sports Exerc 31:38–45PubMedCrossRefGoogle Scholar
  16. 16.
    Fisher NM, Pendergast DR (1997) Reduced muscle function in patients with osteoarthritis. Scan J Rehab Med 29:213–221Google Scholar
  17. 17.
    Goodwin PC, Morrissey MC (2003) Physical therapy after arthroscopic partial menisectomy: is it effective? Exerc Sport Sci Rev 31(2):85–90PubMedCrossRefGoogle Scholar
  18. 18.
    Goodwin PC, Morrissey MC, Omar RZ, Brown M, Southall K, McAuliffe TB (2003) Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy. Phys Ther 6:521–535Google Scholar
  19. 19.
    Goodyear-Smith F, Arroll B (2001) Rehabilitation after arthroscopic meniscectomy: a critical review of the clinical trials. Int Orthop 24:350–353PubMedCrossRefGoogle Scholar
  20. 20.
    Hamberg P, Gillquist J (1984) Knee function after arthroscopic meniscectomy. A prospective study. Acta Orthop Scand 55:172–175PubMedCrossRefGoogle Scholar
  21. 21.
    Huskisson EL (1974) Measurement of pain. Lancet 9:1127–1131CrossRefGoogle Scholar
  22. 22.
    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedGoogle Scholar
  23. 23.
    Mangione KK, McCully K, Gloviak A, Lefebvre I, Hofman M, Craik R (1999) The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. J Gerontol A Biol Sci Med Sci 54:184–190Google Scholar
  24. 24.
    Marx RG et al (2001) Reliability, validity and responsiveness of four knee outcome scales for athletic patients. J Bone Surg (Am) 83:1459–1469Google Scholar
  25. 25.
    Marx RG et al (2005) Multirater agreement of arthroscopic grading of knee articular cartilage. Am J Sports Med 33:1654–1657PubMedCrossRefGoogle Scholar
  26. 26.
    Matsusue Y, Thomson NL (1996) Arthroscopic partial medial meniscectomy in patients over 40 years old: a 5- to 11-year followed-up study. Arthroscopy 12:39–44PubMedCrossRefGoogle Scholar
  27. 27.
    Matthews P, St-Pierre DM (1996) Recovery of muscle strength following arthroscopic meniscectomy. J Orthop Sports Phys Ther 23(1):18–26PubMedGoogle Scholar
  28. 28.
    Menetrey J, Siegrist O, Fritschy D (2002) Medial meniscectomy in patients over the age of fifty: a six year follow-up study. Swiss Surg 8:113–119PubMedCrossRefGoogle Scholar
  29. 29.
    Moffet H, Richards CL, Maloin F, Bravo G, Paradis G (1994) Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: results of a randomized controlled study. Arch Phys Med Rehabil 75:415–426PubMedCrossRefGoogle Scholar
  30. 30.
    Muellner T, Nikolie A, Vécsei V (1999) Recommendations for the diagnosis of traumatic meniscal injuries in athletes. Sports Med 27(5):337–345PubMedCrossRefGoogle Scholar
  31. 31.
    Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg 43B:752–757Google Scholar
  32. 32.
    Pedersen BK, Saltin B (2006) Evidence for prescribing exercise as therapy in chronic disease. Scan J Med Sci Sports 16(Suppl1):3–63CrossRefGoogle Scholar
  33. 33.
    Petersson IF, Boegard T, Saxne T, Silman AJ, Svensson B (1997) Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35–54 years with chronic knee pain. Ann Rheum Dis 56(8):493–496PubMedGoogle Scholar
  34. 34.
    Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP (1995) Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med 23(2):240–244PubMedGoogle Scholar
  35. 35.
    Rangger C, Kathrein A, Klestil T, Gloetzer W (1997) Partial meniscectomy and osteoarthritis. Implications for treatment of athletes. Sports Med 23(1):61–68PubMedCrossRefGoogle Scholar
  36. 36.
    Renström PAF (1995) Knee pain in tennis players. Clin Sports Med 14(1):163–175PubMedGoogle Scholar
  37. 37.
    Risberg MA, Holm I, Steen H, Beynnon BD (1999) Sensitivity to changes over time for the IKDC form, the Lysholm score and the Cincinnati knee score: a prospective study of 120 ACL reconstructed patients with a 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 7(3):152–159PubMedCrossRefGoogle Scholar
  38. 38.
    Rockborn P (2000) Clinical and radiographic outcome of meniscectomy and meniscus repair in the stable knee. Thesis. University of Linköping, SwedenGoogle Scholar
  39. 39.
    Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee injury and osteoarthritis outcome score (KOOS)—validation of Swedish version. Scand J Med Sci Sports 8:439–448PubMedCrossRefGoogle Scholar
  40. 40.
    Roos EM, Roos HP, Ryd L, Lohmander LS (2000) Substantial disability 3 months after arthroscopic partial meniscectomy: a prospective study of patient relevant outcomes. J Arthrosc Rel Surg 16(6):619–626CrossRefGoogle Scholar
  41. 41.
    Roos E (2002) Fysisk aktivitet kan påverka tidig artros. Läkartidningen 45(99):4484–4489Google Scholar
  42. 42.
    Roos E, Lohmander S (2003) The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:1–8CrossRefGoogle Scholar
  43. 43.
    Roos PH, Laurén M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy. Arthritis Rheum 41:687–693PubMedCrossRefGoogle Scholar
  44. 44.
    St-Pierre DM, Laforest S, Paradis S, Leroux M, Charron J, Racette Dalzell MA (1992) Isokinetic rehabilitation after arthroscopic meniscectomy. Eur J Appl Physiol 64(5):437–443CrossRefGoogle Scholar
  45. 45.
    St-Pierre D (1995) Rehabilitation following arthroscopic meniscectomy. Sports Med 20(5):338–347PubMedGoogle Scholar
  46. 46.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49PubMedGoogle Scholar
  47. 47.
    Vervest AM, Maurer CA, Schambergen TG, de Bie RA, Bulstra SK (1999) Effectiveness of physiotherapy after meniscectomy. Knee Surg Sports Traumatol Arthrosc 7(6):360–364PubMedCrossRefGoogle Scholar
  48. 48.
    Weitzel PP, Richmond JC (2002) Critical evaluation of different scoring systems. Sports Med Arthrosc Review 10:183–190CrossRefGoogle Scholar
  49. 49.
    Who/Nut/Ncd (1998) Preventing and managing the global epidemic. Report of world health organization’s consultation on obesity, 3–5 June 1997, Geneva, World Health OrganizationGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Sylvia Herrlin
    • 1
  • Maria Hållander
    • 2
  • Peter Wange
    • 2
  • Lars Weidenhielm
    • 3
    • 4
  • Suzanne Werner
    • 2
  1. 1.Department of PhysiotherapyRehabtjänstStockholmSweden
  2. 2.Capio Artro Clinic, Stockholm Sports Trauma Research CenterKarolinska InstitutetStockholmSweden
  3. 3.Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
  4. 4.Department of OrthopaedicsKarolinska HospitalStockholmSweden

Personalised recommendations