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  • For Patients With Meniscus Tear, Exercise Therapy Outperforms Surgery in Key Muscle Strength Measure

    Exercise therapy can improve certain functions to a degree not possible through arthroscopic surgery for middle-aged patients with degenerative meniscus tears, according to a new study from Denmark. Researchers believe the improvement in function through exercise—more than 16% greater than improvement experienced by the surgery group—may lead to better long-term outcomes.

    In a study that turned the tables on common research that uses exercise therapy as a control group to evaluate the effectiveness of arthroscopic surgery, authors of a study e-published ahead of print in the American Journal of Physical Medicine and Rehabilitation (abstract only available for free) used the surgery group as a control to measure improvements in isokinetic quadriceps strength and neuromuscular function. Such improvements, they write, "can provide functional improvements, pain relief, and possibly also a delay in the onset of osteoarthritis (OA)" in individuals with the tears.

    A total of 82 patients with a degenerative meniscus tear and mild to no OA were placed into 2 groups—1 group underwent arthroscopic partial meniscectomy (APM), and the other was assigned to a 12-week supervised exercise therapy program. Participants had a mean age of 49 years, were able to perform physical activities and exercise, and had not undergone knee surgery in the past 2 years. Males made up 65% of the study group.

    The 12-week exercise program consisted of 2–3 sessions per week, each session lasting 60 to 80 minutes. About 20 minutes was spent in warmup on a stationary cycle, 20–30 minutes on neuromuscular exercise, and another 20–30 minutes on strength training. A physical therapist individually supervised sessions once per week. The APM group received "written and oral instructions for simple home exercises" to be performed 2 to 4 times daily.

    After recording baseline information, researchers assessed isokinetic knee muscle strength, lower extremity performance, and self-reported global rating of change 3 months after intervention.

    While researchers noted no significant differences between the groups in performance tests—knee bends, one-leg hop for distance, and a 6-meter timed hop—or in self-reported assessments of change, a significant improvement occurred in the areas of knee extension total work and knee flexion peak torque. The mean difference of just over 16% reflected improved quadriceps muscle strength that authors write "is effective in relieving pain and improving physical function in patients with knee OA, which could also apply to patients at earlier stages of the degenerative disease."

    Although both the nonsurgical and surgical groups reported about the same levels of self-assessed change after 3 months, researchers speculated that "more invasive procedures are associated with greater placebo effects," which might explain the perceived improvement even in the absence of improvement in muscle strength for the surgical group.

    Authors note that more long-term studies of self-reported pain and function are needed to better compare exercise programs and APM, but they write that their findings are statistically significant enough to support the role of exercise therapy for patients with degenerative meniscus tear.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • For scholarly article

      Posted by Chris on 10/15/2014 1:08 AM

    • This is fantastic! Exactly the kind of research we should be pursuing. We need doctors to be on board with referrals to PT when the signs and symptoms of joint degeneration first show up. Certainly with mild cases, PT should be the first thought in their head to consider along side surgical intervention. This first became a concern of mine when I witnessed arthroscopic surgeries for knees where the surgeon discovered that it wasn't "as bad" as he had thought, but he went ahead and "cleaned it up". Of course, as the decision is by a doctor, no one questions it on the spot. However, I always wondered why a surgeon would aggressively remove non-regenerative tissue that works as the main inhibitor for OA when the pain sx were mild and the structures still very much functional and intact. Working in Geriatrics I can't tell you how many times I run into men and women that can no longer walk due to debilitating knee pain (advanced OA) and they tell me similar stories: I had some knee pain, they "cleaned it up", a bit later it hurt again, they took imaging and the "bones were worn down". I hope I continue to see research that compares PT to surgical interventions. Not only can it improve the quality of life for patients, but it has the potential to save precious health care resource if we can avoid costly non-efficacious surgical procedures. Best Regards, Ray K., PTA

      Posted by Raymond on 11/1/2014 12:46 PM

    • Would PT help if surgery done already, knee still hurts as it may still be torn or may be a new tear.

      Posted by Lydia Nieto-Martinez on 11/5/2014 7:49 AM

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