EXERCISE VS SURGERY
In the Western world, as many as 300 in 100,000 people undergo arthroscopic partial meniscectomy annually. In these patients, most meniscal tears are degenerative and might be regarded as the first sign of osteoarthritis. In a recent meta-analysis, the authors concluded that a small but inconsequential benefit is seen from treatment interventions that involve arthroscopy. This small effect is of short duration and absent one year after surgery. Only one in five randomised controlled trials found greater pain relief one year after partial meniscectomy compared with non-surgical treatment.
Short term and long term follow-up studies have shown that exercise therapy improves function and activity level in patients with degenerative meniscal tears, regardless of whether they have surgery. Only one small pilot study (n=17) compared the effect of surgery alone with exercise alone. Therefore, the aim of this study was to ascertain if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle-aged patients with degenerative meniscal tears.
The observed difference in treatment effect was minute after two years of follow-up. No clinically relevant differences were observed in pain, other symptoms, function in sport and recreation, and knee related quality of life.
These results should encourage clinicians and middle-aged patients with degenerative meniscal tears and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.