Arthroscopic partial meniscectomy is superior to physical rehabilitation in the management of symptomatic unstable meniscal tears

Abstract

Pain and swelling improved after physical therapy. However, patients were not satisfied as limited range of knee motion persisted. APM was superior to physical therapy in treating symptomatic unstable meniscal tears, with high patient satisfaction and restored knee function.

The Treatment of Non-Traumatic Meniscus Lesions

“…The prevalence of nontraumatic meniscus lesions is 31% according to the Framingham study (9). Arthroscopic partial meniscectomy has been the first-line treatment for these injuries for a long time (3,4,(10)(11)(12) and positive clinical outcomes have been demonstrated for this procedure in several cohort studies (10)(11)(12).…”

“…Since previous non-randomized studies have demonstrated benefits for a surgical treatment of meniscus lesions (10)(11)(12), we put forward the hypothesis that there is a subgroup of patients that benefit from surgery.…”

Influence of physiotherapy on knee joint pain after arthroscopy

“…V intervenční skupině tedy došlo k zaznamenání výrazně menší bolestivosti v operovaném kloubu než u skupiny kontrolní. Nižších hodnot škály VAS u 71 pacientů po artroskopické operaci, menisektomii, dosahuje ve svém výzkumu Ghazaly [29]. Symptomatická léčba fyzikální terapií cílená na otok, bez navazující fyzioterapie, dosáhla průměrných hodnot před intervencí 7,4 a po osmi týdnech hodnoty 1,9.…”

Arthroscopic Partial Meniscectomy for Meniscal Tears: A Review and Commentary on a Study by NEJM

“…Symptomatic, unstable meniscus tears require excision to provide a stable meniscal rim. In 2015, El Ghazaly et al 7 published a prospective cohort identifying 70 patients with persistent symptomatic, unstable meniscus tears to evaluate the role of a regimented physical therapy program. Patients who met the inclusion criteria underwent physical therapy and were supervised and instructed by the same physiotherapist three times a week for 8 weeks.…”

“…[8][9][10] Some trials have concluded that there is limited benefit of APM in patients with advanced osteoarthritis, 8,9 while other evidence exists demonstrating some benefit in those with mild to moderate osteoarthritis. 7,10 Herrlin et al 11 first published a prospective, randomized study in 2007, with a subsequent 5-year follow-up study 12 in which 97 patients were randomized either to APM or a rigorous exercise program. Because of persistent symptoms, 28% of the patients in the exercise arm crossed over to APM by 14 months.…”