Early Surgery or Exercise and Education for Meniscal Tears in Young Adults

Skou, Søren Thorgaard; Hölmich, Per; Lind, Martin; Jensen, Hans Peter; Jensen, Carsten; Garval, Mette; Thorlund, Jonas Bloch

doi:10.1056/evidoa2100038

Cited by 21 publications

(32 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Instead, general principles that point to the value of resistance-based, neuromuscular control and plyometric exercises can be used to develop personalised exercisebased programmes. [43][44][45] Clinicians can feel confident about the safety of open and closed chain exercises that target the quadriceps and hamstrings, and neuromuscular electrical stimulation to promote quadriceps strength. In contrast, the expert group recommends caution for the routine use of both blood-flow restriction training, and whole-body vibration to improve quadriceps strength, and against use of continuous passive motion, and knee bracing.…”

Section: Clinical Implications and Call To Actionmentioning

confidence: 99%

OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis

et al. 2022

View full text Add to dashboard Cite

The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries; risk factors for post-traumatic knee OA; rehabilitation to prevent post-traumatic knee OA; and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7–9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5–5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.

show abstract

Section: Clinical Implications and Call To Actionmentioning

confidence: 99%

OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The consensus was that there is a lack of good level 1 studies for the surgical treatment of traumatic meniscus injuries. A new RCT has compared the effects of surgical treatment versus physical therapy for traumatic tears and it suggests that early meniscus surgery is not superior to physical therapy 11. From our study, we can see that younger patients, presumed to have traumatic tears, score lower than a normal population and have similar KOOS results as middle-aged patients after surgery.…”

Section: Discussionmentioning

confidence: 65%

“… 5–10 There is only one RCT, from 2022, that investigate the difference between physical therapy and surgery in younger patients, which suggests that early surgery is not superior to physical therapy. 11 …”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9][10] There is only one RCT, from 2022, that investigate the difference between physical therapy and surgery in younger patients, which suggests that early surgery is not superior to physical therapy. 11 A few studies examine the subjective outcome based on the type of surgery performed, that is, APM or meniscus suture…”

Section: Introductionmentioning

confidence: 99%

“…These report that APM for degenerative meniscus tears is no better than sham surgery or physical therapy 5–10. There is only one RCT, from 2022, that investigate the difference between physical therapy and surgery in younger patients, which suggests that early surgery is not superior to physical therapy 11…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patient’s subjective knee function 3-5 years following partial meniscectomy or meniscus repair compared to a normal population: a retrospective cohort study

Alerskans

Kostogiannis

Neuman

2022

BMJ Open Sport Exerc Med

View full text Add to dashboard Cite

PurposeEvaluate patient-reported knee function after arthroscopic partial meniscectomy (APM) and meniscus suture repair in two different age cohorts compared with a normal population.MethodArthroscopic meniscus surgery was performed on 421 patients at Skåne University Hospital from 2010 to 2014, with a mean (SD) follow-up of 4.2 (1.4) years. Patients and controls were divided into two age cohorts; 18–34 years (younger) and 35–54 years (middle-aged) as well as according to surgery performed; either solely meniscus surgery or with concurrent anterior cruciate ligament reconstruction (ACLR). The outcome is measured with the five subscales of the Knee and Osteoarthritis Outcome Score (KOOS).ResultsNo significant difference in outcome after all studied types of meniscus surgeries between younger-aged and middle-aged patients.Younger patients with APM or meniscus suture repair, with or without, ACLR score lower than the normal population in all subscales of KOOS (p<0.001), except in Activities of Daily Living (ADL) for meniscus suture patients.Middle-aged patients with APM score lower in all subscales than the normal population (p≤0.009). Those with meniscus suture repair score lower than the normal population only for the subscales Sport/Rec and quality of life (p<0.001).Both younger-aged and middle-aged patients achieve better KOOS values after meniscus suture repair and ACLR than after all other combinations of surgery.ConclusionPatients with meniscus injuries do not reach the same KOOS score as the normal population, irrespective of age or type of meniscus surgery performed. However, combined with ACLR in younger-aged and middle-aged patients, meniscus suture gives a better subjective outcome than isolated meniscus surgery.

show abstract

Evaluation and Treatment of Knee Pain

Duong,

Oo,

Ding

et al. 2023

JAMA

View full text Add to dashboard Cite

ImportanceApproximately 5% of all primary care visits in adults are related to knee pain. Osteoarthritis (OA), patellofemoral pain, and meniscal tears are among the most common causes of knee pain.ObservationsKnee OA, affecting an estimated 654 million people worldwide, is the most likely diagnosis of knee pain in patients aged 45 years or older who present with activity-related knee joint pain with no or less than 30 minutes of morning stiffness (95% sensitivity; 69% specificity). Patellofemoral pain typically affects people younger than 40 years who are physically active and has a lifetime prevalence of approximately 25%. The presence of anterior knee pain during a squat is approximately 91% sensitive and 50% specific for patellofemoral pain. Meniscal tears affect an estimated 12% of the adult population and can occur following acute trauma (eg, twisting injury) in people younger than 40 years. Alternatively, a meniscal tear may be a degenerative condition present in patients with knee OA who are aged 40 years or older. The McMurray test, consisting of concurrent knee rotation (internal or external to test lateral or medial meniscus, respectively) and extension (61% sensitivity; 84% specificity), and joint line tenderness (83% sensitivity; 83% specificity) assist diagnosis of meniscal tears. Radiographic imaging of all patients with possible knee OA is not recommended. First-line management of OA comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition. Surgical referral for knee joint replacement can be considered for patients with end-stage OA (ie, no or minimal joint space with inability to cope with pain) after using all appropriate conservative options. For patellofemoral pain, hip and knee strengthening exercises in combination with foot orthoses or patellar taping are recommended, with no indication for surgery. Conservative management (exercise therapy for 4-6 weeks) is also appropriate for most meniscal tears. For severe traumatic (eg, bucket-handle) tears, consisting of displaced meniscal tissue, surgery is likely required. For degenerative meniscal tears, exercise therapy is first-line treatment; surgery is not indicated even in the presence of mechanical symptoms (eg, locking, catching).Conclusions and RelevanceKnee OA, patellofemoral pain, and meniscal tears are common causes of knee pain, can be diagnosed clinically, and can be associated with significant disability. First-line treatment for each condition consists of conservative management, with a focus on exercise, education, and self-management.

show abstract

Early Surgery or Exercise and Education for Meniscal Tears in Young Adults

Cited by 21 publications

References 31 publications

OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis

OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis

Patient’s subjective knee function 3-5 years following partial meniscectomy or meniscus repair compared to a normal population: a retrospective cohort study

Evaluation and Treatment of Knee Pain

Contact Info

Product

Resources

About