Research Report Abstracts

Abstract

Purpose: To compare two treatments for patients with degenerative meniscal injury; high dosage supervised medical exercise therapy versus arthroscopic treatment. Relevance: There is no consensus for treatment of patients with non‐traumatic meniscal tears. Recently, there has been suggested that conservative treatment might be as efficient as arthroscopy, but there exists no exercise therapy guidelines. Participants: 22 patients (17 males), mean age 54 years (SD 11.3) with MRI‐verified degenerative meniscal injury. Methods: A multicenter, pilot study, where patients were randomly assigned either to a high dosage medical exercise therapy group (n = 11) or to arthroscopic treatment (n = 11). Patients in the medical exercise group performed a total of 9 exercises consisting of 3 global exercises using a stationary bike and 6 semiglobal and local exercises doing 3 sets of 30 repetitions of each exercise. The medical exercise group received 3 treatments a week over 3 months. The patients were supervised and the exercises were individually tailored and graded according to the clinical status. The partial arthroscopy consisted of meniscectomy, and the patients did not get systematic postoperative rehabilitation. Patients were assessed at inclusion and end of treatment, the arthroscopy group three months after surgery. Pain was measured using a visual analogue scale (VAS), function was registered using the Knee injury and Osteoarthritis Outcome Score (KOOS) and mental status with Hospital Anxiety and Depression (HAD) Scale. Analysis: Differences between the groups were analyzed using a one‐tailed independent‐sample t‐test. Results: There were no statistical differences between the two groups at baseline. During treatment 4 patients (18%) dropped out; 3 from the exercise group and 1 from the arthroscopy group. At end of treatment there were no statistically differences between the two groups. Conclusions: With the low number of participants in mind, in patients with non‐traumatic meniscal injury, arthroscopy was not superior to medical exercise therapy alone in terms of knee pain and overall daily function. Medical exercise therapy might be an efficient treatment approach and should be considered as a treatment alternative. Implications: In light of the present results from this pilot study, high dosage medical exercise therapy could be recommended as a preferred treatment, at least before surgery. The therapist should supervise the patient constantly in progression of the exercises, according to the patients' clinical picture. Further research should be completed as randomized controlled trials, and also include postoperative treatment and osteoarthritis.