Exercise vs Surgery for a degenerative meniscal tear. Yay or nay?

5th Sep, 2022

Key Points

  1. Patients with degenerative meniscus tears and no radiographic evidence of OA should consider exercise therapy over surgery.
  2. There is no clinically relevant difference between exercise and surgery for a degenerative meniscal tear.
  3. Supervised exercise therapy showed better results in terms of improving thigh muscle strength.

What is a degenerative meniscus tear? 

The meniscus is a piece of cartilage found in the knee with low blood penetration and poor healing potential. The meniscus serves as a structure for joint stability, shock absorption, contact force distribution, and most importantly, plays a role in the smooth gliding of our knee joints. A meniscus tear has two classifications: acute and degenerative. Acute tears occur from traumatic injuries, whereas degenerative tears are non-traumatic, and a result of repetitive normal forces acting on a worn down meniscus.

A degenerative meniscus tear holds poor potential for full recovery, but can instead be managed by non-invasive interventions such as exercise or arthroscopic partial meniscectomy.

Can we do anything about a degenerative meniscus tear?

In order to compare which intervention is better for a degenerative meniscal tear, a randomised control trial was conducted to compare the outcomes of 12 weeks of exercise therapy versus an arthroscopic partial meniscectomy. The participants in this study were middle-aged, all of whom had degenerative meniscus tears.

The experiment was conducted and concluded that arthroscopic surgery holds a small benefit for only a short period of time. As arthroscopic surgery is such a common procedure, and if the results of it are inconsequential, alternative treatments should be explored for the benefit of future patients.

What is the difference between the surgical and non-surgical groups?

Based on the study, here are some differences between the patients who received arthroscopic partial meniscectomy, and those who received exercise therapy:

Arthroscopic Partial Meniscectomy Exercise Therapy
At 1 year follow up, patient reported outcome was better, though this was not consistent at 3rd month and 2 year follow up Improved thigh muscle strength for short term
Significantly fewer knee symptoms such as swelling, mechanical problems, and restricted Range of Motion
Better muscle strength, but did not have improved functional performance

If surgery has only a small benefit, what else can be done?

Exercise therapy is a non-invasive alternative to arthroscopic partial meniscectomy that is able to provide similar benefits without the risks or recovery time required from surgery.

The exercise therapy program designed for this study includes progressive neuromuscular and strength exercises. Neuromuscular exercises focus on improving the quality of movement, and the position of the trunk and lower limbs relative to one another, all while dynamically and functionally increasing the strength of the lower limb muscles. The therapy is done over the course of 12 weeks with a minimum of 2 sessions, and maximum of 3 sessions performed each week.

Who will benefit from exercise therapy? 

Degenerative meniscus tears occur most often in middle aged patients. Exercise therapy therefore can benefit this group of patients in conservatively managing their knee condition while avoiding surgery if possible.

Individuals over the age of 50 are at higher risk of degenerative knee conditions that can develop into osteoarthritis (OA). Exercise therapy is beneficial especially for middle aged patients, as a conservative method of managing degenerative meniscus tears in terms of pain and function

What are your next steps after reading this?

The study concluded no significant differences between treatments in terms of patient reported outcomes. However, patient reported outcomes are prone to placebo effects, more so after an invasive intervention such as surgery. This is not to say that non-invasive treatments are not prone to placebo, but they are typically less obvious.

This study has shown that exercise therapy has positive effects over arthroscopic partial meniscectomy in short term improvement such as thigh muscle strength. While it did not do better in terms of patient reported outcomes, the results showed comparable improvements between the two interventions.

Both treatments were concluded to have minimal differences after the 2nd year follow up.

A degenerative meniscus tear is not a condition that surgery can fix. Rather, it is a chronic condition that should be managed consistently. This study has proven that exercise therapy is a comparable treatment to arthroscopic partial meniscectomy as both interventions have similar patient reported outcomes. In addition, exercise therapy increases the strength of thigh muscles, which are essential in our daily function, such as walking.

Exercise therapy and knee arthroscopy were similarly effective for pain relief and other patient reported outcomes in a younger, more active population with a lower body mass index than previously studied.

Exercise therapy resulted in better thigh muscle strength than surgery. Supervised exercise therapy should be considered as a treatment option for patients with pain and degenerative meniscal tears verified by magnetic resonance imaging, and without radiographic signs of osteoarthritis.

These results should encourage your Physiotherapists and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.

Unsure of what to do? Contact us to speak to our Rehab Centre Physiotherapist who will be able to ascertain the source of pain and have it addressed appropriately! We may also refer you to an appropriate knee surgeon who will be able to advise if surgery if Physiotherapy doesn’t help to reduce your symptoms. 

DISCLAIMER: These advice or exercises should not replace the need for a consultation with a Physiotherapist especially if your condition doesn’t improve. Therapeutic exercise should be carefully selected to suit your condition.

Ref: 
Kise, N., Risberg, M., Stensrud, S., Ranstam, J., Engebretsen, L., & Roos, E. (2016). Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ, i3740. https://doi.org/10.1136/bmj.i3740

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