A study says that exercise therapy is as effective as surgery for middle aged patients with a common type of knee injury known as meniscal tear. According to a report in the British Medical Journal, researchers say that every year at least two million people undergo knee arthroscopy (keyhole surgery to relieve pain and improve movement). Yet they say that evidence suggest that arthroscopic surgery offers little benefit for most patients.
So researchers based in Denmark and Norway carried out a randomised controlled trial to compare exercise therapy alone with arthroscopic surgery alone in middle aged patients with degenerative meniscal tears.
They identified 140 adults with degenerative meniscal tears at two public hospitals and two physiotherapy clinics in Norway. Almost all (96%) participants had no definitive x-ray evidence of osteoarthritis. Half of the patients received a supervised exercise programme over 12 weeks (2-3 sessions each week) and half received arthroscopic surgery followed by simple daily exercises to perform at home.
Thigh muscle strength was assessed at three months and patient reported knee function was recorded at two years. No clinically relevant difference was found between the two groups for outcomes such as pain, function in sport and recreation, and knee related quality of life. At three months, muscle strength had improved in the exercise group.
No serious adverse events occurred in either group during the two-year follow-up. Thirteen (19%) of participants in the exercise group crossed over to surgery during the follow-up period, with no additional benefit.
"Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term," say the authors. "Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no radiographic evidence of osteoarthritis to consider supervised structured exercise therapy as a treatment option."
