Exercise therapy may be as effective as arthroscopic partial meniscectomy in treating degenerative meniscal tears [synopsis]

摘要

Summary of: Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engrebretsen L, Roos EM. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle- aged patients: randomised controlled trial with two year follow up. BMJ 2016;354:i3740. Question: In patients with degenerative meniscal tears, does super- vised exercise therapy lead to greater improvements in knee function than arthroscopic partial meniscectomy? Design: Randomised, con- trolled trial with concealed allocation. Setting: Orthopaedic depart- ments at two public hospitals and two physiotherapy clinics in Norway. Participants: Patients were included if they: were aged 35 to 60 years; had unilateral knee pain > 2 months without major trauma; had medial degenerative meniscal tear verified by magnetic resonance imaging; had radiographic changes grade 2 (Kellgren- Lawrence); were eligible for arthroscopy; were able to participate in exercise therapy; and were able to understand Norwegian. Rando- misation of 140 patients allocated 70 to the exercise group and 70 to the surgery group. Interventions: Exercise therapy consisted3[_TD$DFIF] of two to three sessions per week of physiotherapist-supervised progressive neuromuscular and strength exercises over 12 weeks[I1$_FTDDF] (24 to 36 ses- sions). For the surgery group, standard operations for arthroscopic partial meniscectomy was performed, followed by normal preopera- tive, perioperative and postoperative routines, including encourage- ment to perform simple exercises to reduce swelling and regain range DD_[T4$IFF]two to [5_TDI$DF]Ffour times daily after discharge home on the day of surgery. Outcome measures: The primary patient-reported outcome was knee1836-9553/ 2016 Australian Physiotherapy Association. Published by Elsevier B creativecommons.org/licenses/by-nc-nd/4.0/).function at 12 and 24 months measured by the Knee injury and Osteoarthritis Outcome Score (KOOS) from 0 (worst) to 100 (best); and the primary clinician-measured outcome was thigh muscle strength, measured with a Biodex dynamometer for quadriceps and hamstring isokinetic concentric muscle strength at 3 months. Results: A total of 129 participants (92%) completed 3 and 12 months follow-up, and 126 (90%) completed 24 months follow-up. The mean difference in2[_$TDDIFF] KOOS was 0.9 points (95% CI 4.3 to 6.1) at 24 months. At 3 months, all muscle strength variables had improved in the exercise group compared with the surgery group (p 0.004). Cross- over to surgery occurred in 19% of the participants allocated to exercise therapy, with no additional benefit. Conclusion: Exercise therapy resulted in better thigh muscle strength than surgery after 3 months, but there was no difference in self-reported knee function. Supervised exercise therapy should be considered as a treatment option for patients with pain and degenerative meniscal tears. Provenance: Invited. Not peer 6[_$TDDIFF] reviewed.Margreth Grotlea and Ka?re Birger Hagenb aOslo and Akershus University College of Applied Sciences, Department of Physiotherapy, Oslo, Norway bNational Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway http://dx.doi.org/10.1016/j.jphys.2016.10.009.