Comparison of arthroscopic partial meniscectomy with physical therapy alone co existing meniscal tear and knee osteoarthritis

Atul Mahajan; Anil Mehtani

doi:10.18203/issn.2455-4510.IntJResOrthop20173935

Authors

Atul Mahajan Department of Orthopedics, Lady Hardinge Medical College, New Delhi, India
Anil Mehtani Department of Orthopedics, Lady Hardinge Medical College, New Delhi, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20173935

Keywords:

Menisectomy, Knee injury and osteoarthritis outcome score, Western Ontario and McMaster universities osteoarthritis index, Osteoarthritis

Abstract

Background: In patients with a meniscal tear and mild-to moderate osteoarthritis, we analyzed whether arthroscopic partial meniscectomy improve physical and functional outcomes more than physical therapy does.

Methods: 52 patients had a meniscal tear as well as osteoarthritis confirmed by magnetic resonance imaging or radiography. Symptoms had persisted for more than 3 months despite conservative measures. Patients were allocated to Group A subjected to partial meniscectomy and postoperative physical therapy (n=26) or to Group B with physical therapy alone (n=26). The primary outcome measure was change on the physical-function scale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) during the 6 months after randomization. A 12-month assessment was added to determine the stability of the result. Secondary outcomes were the pain score on the Knee Injury and Osteoarthritis Outcome Score (KOOS).

Results: At 6 months, the 2 groups did not differ in mean improvement in the WOMAC physical-function score, in decreases on the KOOS pain score. The results were similar at 12 months.

Conclusions: In patients with a meniscal tear and mild-tomoderate osteoarthritis, both groups showed similar outcomes between arthroscopic meniscectomy and physical therapy.

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References

Moseley JB, O’Malley K, Petersen NJ. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347:81-8.

Kirkley A, Birmingham TB, Litchfield RB. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008;359:1097-107.

Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2008;4:CD004376.

Fransen M, McConnell S. Land-based exercise for osteoarthritis of the knee: a meta-analysis of randomized controlled trials. J Rheumatol. 2009;36:1109-17.

Katz JN, Chaisson CE, Cole B. The Meteor trial (Meniscal Tear in Osteoarthritis Research): rationale and design features. Contemp Clin Trials. 2012;33:1189-96.

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833-40.

Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS) — development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28:88- 96.

Singh AJ, Singh YN. Rehabilitation Following Arthroscopic Partial Meniscectomy –A Neglected Issue. Indian J Physical Med Rehab. 2004;15:1-6.

Akima H, Furukawa T. Atrophy of thigh muscles after meniscal lesions and arthroscopic partial meniscectomy. Knee Surgery Sports Traumatol Arthroscpy. 2005;13:632-7.

Morrissey MC, Milligan P, Goodwin PC. Evaluating treatment effectiveness:Benchmarks for rehabilitation after partial meniscectomy knee arthroscopy. Am J Physical Med Rehab. 2006;6:490-501.

Gapeyeva H, Paasuke M, Ereline J, Pintsaar A, Eller A. Isokinetic torque deficit of the knee extensor muscles after arthroscopic partial meniscectomy. Knee Surgery Sports Traumatol Arthroscopy. 2000;8:301-4.

Al-Dadah O, Sheptone L, Donnell ST. Proprioception following partial meniscectomy in stable knees. Knee Surgery Sports Traumatol Arthroscpy. 2011;19:207-13.

Malliou P, Gioftsidou G, Pafis G, Rokka S, Kofotolis N, Mavromoustakos S, Godolias G. Proprioception and functional deficits of partial meniscectomized knees. Euro J Physical Rehab Med. 2012;2:231-6.

Moffet H, Richards CL, Malouin F, Bravo G, Paradis G. Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: Results of a randomized controlled study. Arch Physical Med Rehab. 1994;75:415-25.

Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears:a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc. 2007;15:393-401.

Herrlin SV, Wange PO, Lapidus G, Hallander M, Werner S, Weidenhielm L. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc. 2013;21:358-64.

Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, et al. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. N Engl J Med. 2013;368(18):1675-84.