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Exercise could be as effective as surgery for knee damage

Study questions widespread practice treating knee problems

Adrian O'Dowd

Thursday, 21 July 2016

Exercise therapy for middle aged people with knee damage could be just as effective as having surgery, claims a study* published online today in The BMJ.

An estimated 2 million people worldwide undergo knee arthroscopy (keyhole surgery to relieve pain and improve movement) every year at considerable cost, but current evidence suggests that this form of knee surgery offers little benefit for most patients.

Researchers based in Denmark and Norway, therefore, carried out a randomised controlled trial to compare exercise therapy alone with arthroscopic surgery alone in middle aged patients with degenerative meniscal tears.

For the study, they identified 140 adults (average age 50) with degenerative meniscal tears at two public hospitals and two physiotherapy clinics in Norway. Almost all (96%) participants had no definitive x-ray evidence of osteoarthritis.

Half of the patients received a supervised exercise programme over 12 weeks (to two to three sessions each week) and half received arthroscopic surgery followed by simple daily exercises to perform at home.

The participants’ thigh muscle strength was assessed three months later and patient-reported knee function was recorded two years later.

The researchers found there was no clinically relevant difference between the two groups for outcomes such as pain, function in sport and recreation, and knee-related quality of life.

Three months after the start of the study period, muscle strength had improved in the exercise group.

During the two years follow-up, no serious adverse events occurred in either group.

A small proportion (19%) of participants in the exercise group crossed over to surgery during the follow-up period, with no additional benefit.

The authors said: “Supervised 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 radiographic evidence of osteoarthritis to consider supervised structured exercise therapy as a treatment option.”

In a linked editorial,** Teppo Järvinen at the University of Helsinki, Finland, and Gordon Guyatt at McMaster University in Canada, said: “Essentially, good evidence has been widely ignored.

“In a world of increasing awareness of constrained resources and epidemic medical waste, what we should not do is allow the orthopaedic community, hospital administrators, healthcare providers, and funders to ignore the results of rigorous trials and continue widespread use of procedures for which there has never been compelling evidence.”

*  Kise NJ, et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomized controlled trial with two year follow-up. BMJ 2016;354:i3740. DOI: 10.1136/bmj.i3740

** Järvinen TLN, Guyatt GH. Arthroscopic surgery for knee pain. BMJ 2016;354:i3934. DOI: 10.1136/bmj.i3934

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