Man with sore kneeI’m glad to see surgery subjected to meaningful control studies.  That’s the standard for Acupuncture research except we also have the additional burden of adding sham acupuncture as a study arm.  Surgical studies, for some reason, don’t need add a sham arm.

Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up

BMJ 2016;

  1. Nina Jullum Kise, orthopaedic surgeon1,
  2. May Arna Risberg, physiotherapist and professor2 3 4,
  3. Silje Stensrud, physiotherapist2,
  4. Jonas Ranstam, independent statistician and professor5,
  5. Lars Engebretsen, orthopaedic surgeon and professor3 6 7,
  6. Ewa M Roos, physiotherapist and professor8

Author affiliations

  1. Correspondence to: N J Kise nina.kise@mhh.no
  • Accepted 26 June 2016

Abstract

Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears.

Design Randomised controlled superiority trial.

Setting Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway.

Participants 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis.

Interventions 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone.

Main outcome measures Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months.

Results No clinically relevant difference was found between the two groups in change in KOOS4 at two years (0.9 points, 95% confidence interval −4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit.

Conclusion The observed difference in treatment effect was minute after two years of follow-up, and the trial’s inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment