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Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients : Randomised controlled trial with two year follow-up

Kise, Nina Jullum; Risberg, May Arna; Stensrud, Silje; Ranstam, Jonas LU ; Engebretsen, Lars and Roos, Ewa M. LU (2016) In BMJ (International Edition)1988-01-01+01:002008-01-01+01:00 354.
Abstract

Objective: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design: Randomised controlled superiority trial. Setting: Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. Participants: 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions: 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. Main outcome measures: Intention to treat analysis of between group difference in change in knee injury and osteoarthritis... (More)

Objective: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design: Randomised controlled superiority trial. Setting: Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. Participants: 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions: 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. Main outcome measures: Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS 4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months. Results: No clinically relevant difference was found between the two groups in change in KOOS 4 at two years (0.9 points, 95% confidence interval â'4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. Conclusion: The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BMJ (International Edition)1988-01-01+01:002008-01-01+01:00
volume
354
publisher
BMJ Publishing Group
external identifiers
  • Scopus:84979545071
ISSN
0959-8146
DOI
10.1136/bmj.i3740
language
English
LU publication?
yes
id
1b6dffd4-fd21-403c-8e03-093d58d391a7
date added to LUP
2016-08-17 12:49:33
date last changed
2016-11-27 04:42:10
@misc{1b6dffd4-fd21-403c-8e03-093d58d391a7,
  abstract     = {<p>Objective: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design: Randomised controlled superiority trial. Setting: Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. Participants: 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions: 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. Main outcome measures: Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS 4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months. Results: No clinically relevant difference was found between the two groups in change in KOOS 4 at two years (0.9 points, 95% confidence interval â'4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. Conclusion: The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.</p>},
  author       = {Kise, Nina Jullum and Risberg, May Arna and Stensrud, Silje and Ranstam, Jonas and Engebretsen, Lars and Roos, Ewa M.},
  issn         = {0959-8146},
  language     = {eng},
  month        = {07},
  publisher    = {ARRAY(0x835b5c0)},
  series       = {	BMJ (International Edition)1988-01-01+01:002008-01-01+01:00},
  title        = {Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients : Randomised controlled trial with two year follow-up},
  url          = {http://dx.doi.org/10.1136/bmj.i3740},
  volume       = {354},
  year         = {2016},
}