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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 1, pp 200–206 | Cite as

Is postoperative exercise therapy necessary in patients with degenerative meniscus? A randomized controlled trial with one year follow-up

  • Håvard ØsteråsEmail author
  • Berit Østerås
  • Tom Arild Torstensen
Knee

Abstract

Purpose

There is no consensus on a postoperative rehabilitation regimen for patients who have undergone surgery for medial meniscus damage. The aim of this investigation was to evaluate two rehabilitation approaches after arthroscopic surgery in patients with degenerative meniscus: supervised medical exercise therapy versus no treatment.

Methods

A prospective randomized controlled clinical trial. Over 4 months, 70 participants were randomly assigned into either a medical exercise therapy group (n = 36) or a control group (n = 34). Pain was a composite score of a visual analogue scale (VAS), and function was measured with a functional assessment questionnaire (KOOS), while anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Function was also measured with tests of quadriceps femoris strength and a one-leg jump test.

Results

Prognostic variables were similar between the groups at baseline, with five (7 %) patients dropping out during the treatment period and another six (8 %) before the one-year follow-up. After 3 months, the medical exercise therapy group achieved significantly better outcome effects than the control group for pain and function. The results after the 12-month follow-up indicated the same results as at posttest, whereas Hospital Anxiety and Depression Scale, fiveRM and the one-leg hop test also demonstrated a significant difference between the groups from pre- to posttest to follow-up.

Conclusion

In patients with surgery for degenerative meniscus damage, postoperative medical exercise therapy is an efficient treatment alternative compared to no treatment.

Level of evidence

I.

Keywords

Knee function Rehabilitation Physical therapy Knee pain 

Notes

Acknowledgments

The physical therapists Lasse Haugerud and Eivind Selven deserve recognition for their important contribution in completing the tests and interventions.

References

  1. 1.
    Akkaya N, Ardin F, Ozgen M, Akkaya S, Sahin F, Kilic A (2012) Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy; a randomized controlled trial. Clin Rehabil 26(3):224–236PubMedCrossRefGoogle Scholar
  2. 2.
    Bjelland I, Dahl AA, Haug TT et al (2002) The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res 52(2):69–77PubMedCrossRefGoogle Scholar
  3. 3.
    Bremander AB, Dahl LL, Roos EM (2007) Validity and reliability of functional performance tests in meniscectomized patients with or without knee osteoarthritis. Scand J Med Sci Sports 17(2):120–127PubMedGoogle Scholar
  4. 4.
    Burks RT, Metcalf MH, Metcalf RW (1997) Fifteen-year follow-up of arthroscopic partial meniscectomy. Arthroscopy 13:673–679PubMedCrossRefGoogle Scholar
  5. 5.
    Börjesson M, Robertson E, Weidenhielm L, Mattsson E, Olsson E (1996) Physiotherapy in knee osteoarthrosis: effect on pain and walking. Physiother Res Int 1:89–97PubMedCrossRefGoogle Scholar
  6. 6.
    Conroy DE, Hayes KW (1998) The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome. J Orthop Sports Phys Ther 28(1):3–14PubMedCrossRefGoogle Scholar
  7. 7.
    Drouin JM, Valovich-mcLeod TC, Shultz SJ, Gansneder BM, Perrin DH (2004) Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol 91(1):22–29PubMedCrossRefGoogle Scholar
  8. 8.
    Dye SF (2001) Therapeutic implications of a tissue homeostasis approach to patellofemoralt pain. Sports Med Arthrosc Rev 9:306–311CrossRefGoogle Scholar
  9. 9.
    Englund M, Roos EM, Lohmander LS (2003) Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year follow-up of meniscectomy with matched controls. Arthritis Rheum 48(8):2178–2187PubMedCrossRefGoogle Scholar
  10. 10.
    Goodwin PC, Morrisey MC (2003) Physical Therapy After Arthroscopic Partial Meniscectomy: Is It Effective?. Exerc Sport Sci Rew:85–90Google Scholar
  11. 11.
    Herrlin S, Hållander M, Wange P, Weidenhielm L, Werner S (2007) Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 15(4):393–401PubMedCrossRefGoogle Scholar
  12. 12.
    Holm I, Hammer S, Larsen S, Nordsletten L, Steen H (1995) Can a regular leg extension bench be used in testing deficits of the quadriceps muscle during rehabilitation? Scand J Med Sci Sports 5(1):29–35PubMedCrossRefGoogle Scholar
  13. 13.
    Huskisson EL (1974) Measurement of pain. Lancet 9:1127–1131CrossRefGoogle Scholar
  14. 14.
    Kjær P (2003) Role of extracellular matrix in adaptation of tendon and skeletal muscle to mechanical loading. Physiol Rev 83:649–698Google Scholar
  15. 15.
    Matthews P, St-Pierre DM (1996) Recovery of muscle strength following arthroscopic meniscectomy. J Orthop Sports Phys Ther 23(1):18–26PubMedCrossRefGoogle Scholar
  16. 16.
    Moffet H, Richards CL, Malouin 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(4):415–426PubMedCrossRefGoogle Scholar
  17. 17.
    Morrissey MC, Milligan P, Goodwin PC (2006) Evaluating treatment effectiveness: benchmarks for rehabilitation after partial meniscectomy knee arthroscopy. Am J Phys Med Rehabil 85:490–501PubMedCrossRefGoogle Scholar
  18. 18.
    Pedersen BK, Saltin B, Saltin B (2006) Evidence for prescribing exercise as therapy in chronic disease. Scan J Med Sci Sports 16(Suppl1):3–63CrossRefGoogle Scholar
  19. 19.
    Powers CM, Heino JG, Rao S, Rao S, Perry J (1999) The influence of pain on lower limb loading during gait. Clin Biomech (Bristol, Avon) 14:722–728CrossRefGoogle Scholar
  20. 20.
    Roos PH, Laurèn M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy. Arthritis Rheum 41:687–693PubMedCrossRefGoogle Scholar
  21. 21.
    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
  22. 22.
    Roos EM, Ostenberg A, Roos H, Ekdahl C, Lohmander LS (2001) Long-term outcome of meniscectomy: symptoms, function, and performance tests in patients with or without radiographic osteoarthritis compared to matched controls. Osteoarthr Cartil 9(4):316–324PubMedCrossRefGoogle Scholar
  23. 23.
    Roos EM, Bremander AB, Englund M, Lohmander LS (2008) Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee osteoarthritis. Ann Rheum Dis 67(4):505–510PubMedCrossRefGoogle Scholar
  24. 24.
    Spector TD, Cooper C (1993) Radiographic assessment of osteoarthritis in population studies: whither Kellgren and Lawrence? Osteoarthr Cartil 1(4):203–206PubMedCrossRefGoogle Scholar
  25. 25.
    Torstensen TA (1999) Medical Exercise Therapy for dysfunction of hip, knee and ankle—dysfunction of the lower extremity. Oslo: Holten Institute, (ISBN 82-92018-04-2)Google Scholar
  26. 26.
    Vlayen JWS, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332CrossRefGoogle Scholar
  27. 27.
    Waddel G (1996) Keynote address for primary care forum. Low back pain: a twentieth century health care enigma. Spine 21:2820–2825CrossRefGoogle Scholar
  28. 28.
    Østerås H, Østerås B, Torstensen TA (2012) Medical exercise therapy or arthroscopic surgery in degenerative meniscus damage patients. J Bodyw Mov Ther 16(4):456–463PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Håvard Østerås
    • 1
    Email author
  • Berit Østerås
    • 2
  • Tom Arild Torstensen
    • 3
  1. 1.Sør-Trøndelag University College, Faculty of Health Education and Social WorkDepartment of Physical TherapyTrondheimNORWAY
  2. 2.Trøndelag University CollegeTrondheimNorway
  3. 3.Holten InstituteLidingöSverige

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