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Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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.

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References

  1. Ahlbäck S (1968) Osteoarthritis of the knee. A radiographic investigation. Acta Radiol 277:7–72

    Google Scholar 

  2. Bhattacharyya T, Gale D, Dewire P, Totterham S, Gale E, McLaughlin S, Einhorn TA, Felson DT (2003) The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Joint Surg Am 85:4–9

    PubMed  Google Scholar 

  3. Burks RT, Metcalf M, Metcalf R (1997) Fifteen-year follow-up of arthroscopic partial meniscectomy. Arthroscopy 13:673–679

    Article  PubMed  CAS  Google Scholar 

  4. 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 31:83–86

    PubMed  Google Scholar 

  5. Desai VV, Ackroyd CE (2000) Resection of degenerate menisci: is it useful? Knee 7(3):179–182

    Article  PubMed  Google Scholar 

  6. Englund M, Niu J, Guermazi A, Roemer FW, Hunter DJ, Lynch JA et al (2007) Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness. Arthritis Rheum 56:4048–4054

    Article  PubMed  CAS  Google Scholar 

  7. Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT (2008) Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 359:1108–1115

    Article  PubMed  CAS  Google Scholar 

  8. Englund M, Guermazi A, Lohmander SL (2009) The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiol Clin North Am 47:703–712

    Article  PubMed  Google Scholar 

  9. Ericsson YB, Roos EM, Dahlberg L (2006) Muscle strength, functional performance, and self-reported outcomes four years after arthroscopic partial meniscectomy: a randomized trial. Arthritis Rheum 55:946–952

    Article  PubMed  Google Scholar 

  10. Goodwin PC, Morrissey MC (2003) Physical therapy after arthroscopic partial meniscectomy: is it effective? Exerc Sport Sci Rev 31:85–90

    Article  PubMed  Google Scholar 

  11. Goodyear-Smith F, Arroll B (2001) Rehabilitation after arthroscopic meniscectomy: a critical review of the clinical trials. Int Orthop 24:350–353

    Article  PubMed  CAS  Google Scholar 

  12. Hamberg P, Gillquist J (1984) Knee function after arthroscopic meniscectomy. A prospective study. Acta Orthop Scand 55:172–175

    Article  PubMed  CAS  Google Scholar 

  13. Herrlin S, Hållander M, Wange P, Weidenhielm L, Werner S (2007) Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 15:393–401

    Article  PubMed  Google Scholar 

  14. Huskisson EC (1974) Measurement of pain. Lancet 2:1127–1131

    Article  PubMed  CAS  Google Scholar 

  15. Kirkley A, Birmingham T, Litchfield R, Giffin R, Willits K, Wong C et al (2008) A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 359:1097–1107

    Article  PubMed  CAS  Google Scholar 

  16. Marx RG, Connor J, Lyman S, Amendola A, Andrish JT, Kaeding C et al (2005) Multirater agreement of arthroscopic grading of knee articular cartilage. Am J Sports Med 33:1654–1657

    Article  PubMed  Google Scholar 

  17. 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 75:415–426

    Article  PubMed  CAS  Google Scholar 

  18. Mosely JB, O’Malley K, Petersen N, Menke TJ, Brody BA, Kuykendall DH et al (2002) A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2:81–88

    Article  Google Scholar 

  19. Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg 43:752–757

    Google Scholar 

  20. Rimington T, Malik K, Evans D, Mroczek K, Reider B (2009) A prospective study of the nonoperative treatment of degenerative meniscus tears. Orthopedics 32:558–563

    Article  Google Scholar 

  21. 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 8:439–448

    Article  PubMed  CAS  Google Scholar 

  22. Roos EM, Roos H, Ryd L, Lohmander LS (2000) Substantial disability after arthroscopic partial meniscectomy: a prospective study of patient relevant outcomes. Arthroscopy 16:619–626

    Article  PubMed  CAS  Google Scholar 

  23. Roos EM, Lohmander SL (2003) The knee injury and osteoarthritis outcome score (KOOS): from injury to osteoarthritis. Health Qual Life Outcomes 1:1–8

    Article  Google Scholar 

  24. St-Pierre DM (1995) Rehabilitation following arthroscopic meniscectomy. Sports Med 20:338–347

    Article  PubMed  CAS  Google Scholar 

  25. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49

    PubMed  Google Scholar 

  26. Vervest AM, Maurer CA, Schambergen TG, de Bie RA, Bulstra SK (1999) Effectiveness of physiotherapy after meniscectomy. Knee Surg Sports Traumatol Arthrosc 7:360–364

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Elisabeth Berg, Lime, Karolinska Institutet for the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Physiotherapy, Herrlin Invest, Tunavägen 8, 181 65, Lidingö, Sweden

    Sylvia V. Herrlin

  2. Capio Artro Clinic, Sports Trauma Research Center, Karolinska Institutet, Valhallavägen 91, 114 27, Stockholm, Sweden

    Peter O. Wange, Maria Hållander & Suzanne Werner

  3. Unilabs, S:t Göran Röntgen, S:t Göransplan 1, 112 81, Stockholm, Sweden

    Gunilla Lapidus

  4. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Lars Weidenhielm

  5. Department of Orthopedics, Karolinska University Hospital, 171 76, Stockholm, Sweden

    Lars Weidenhielm

Authors
  1. Sylvia V. Herrlin
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  2. Peter O. Wange
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  3. Gunilla Lapidus
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  4. Maria Hållander
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  5. Suzanne Werner
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  6. Lars Weidenhielm
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Corresponding author

Correspondence to Sylvia V. Herrlin.

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Herrlin, S.V., Wange, P.O., Lapidus, G. et al. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc 21, 358–364 (2013). https://doi.org/10.1007/s00167-012-1960-3

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  • DOI: https://doi.org/10.1007/s00167-012-1960-3

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