Exercise therapy bests surgery in patients with degenerative meniscal tear: JAMA

Netherlands: In patients with a degenerative meniscal tear, exercise-based physical therapy is not inferior to arthroscopic partial meniscectomy in regards to knee function, reports an article published in JAMA Network Open.

A degenerative meniscal tear results from repetitive normal forces acting upon a worn-down meniscus. Reports estimated a 35% prevalence of degenerative meniscal tears in people over 50 years of age, with a similar prevalence in those with and without knee pain (20%vs 25%).

Exercise therapy is an effective intervention for individuals with degenerative meniscal tears and knee symptoms, without the associated risks of arthroscopic partial meniscectomy surgery. Surgery is the last resort for a degenerative meniscus tear. There is a scarcity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears.

Julia C., OLVG Amsterdam, the Netherlands, and colleagues conducted a noninferiority randomized clinical trial to compare the 5-year effectiveness of arthroscopic partial meniscectomy and exercise-based physical therapy on patient-reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscal tear. 

Researchers included a total of 321 patients aged 45 to 70 years with a degenerative meniscal tear in the clinical trial conducted in the orthopedic departments of 9 hospitals in the Netherlands. Patients were randomly allocated to arthroscopic partial meniscectomy or 16 sessions of exercise-based physical therapy.

The primary outcome was set as patient-reported knee function (International Knee Documentation Committee Subjective Knee Form (range, 0 [worst] to 100 [best]) during 5 years of follow-up based on the intention-to-treat principle, with a noninferiority threshold of 11 points. The secondary outcome was progression in knee osteoarthritis shown on radiographic images in both treatment groups

Key findings of the study,

• The mean improvement was 29.6 points in the surgery group and 25.1 points in the physical therapy group

• The crude between-group difference was 3.5 points.

• Comparable rates of progression of radiographic-demonstrated knee osteoarthritis were noted between both treatments.

The authors conclude that exercise-based physical therapy remains non-inferior to arthroscopic partial meniscectomy for patient-reported knee function. The study showed a small and comparable progression of knee osteoarthritis OA in both groups.

Physical therapy should be the preferred treatment over surgery for degenerative meniscal tears. The present study provides evidence for the development and update of current guideline recommendations for the treatment of patients with a degenerative meniscal tear, the authors commented.

Reference:

Noorduyn JCA, van de Graaf VA, Willigenburg NW, et al. Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial. JAMA Netw Open. 2022;5(7):e2220394. doi:10.1001/jamanetworkopen.2022.20394