Clinical issue:
It was thought that the clinical outcomes of arthroscopic meniscectomy will be better than those of nonoperative treatment for a degenerative
horizontal tear of the medial meniscus.
The study:
In a randomized controlled trial (level 1 evidence), a total of
102 patients with knee pain and a degenerative horizontal tear of the
posterior horn of the medial meniscus on
magnetic resonance imaging werefollowed up between January 2007 and July 2009. The study included 81 female
and
21 male patients with an average age of 53.8
years (range, 43-62 years). Fifty patients underwent arthroscopic
meniscectomy
(meniscectomy group), and 52 patients underwent
nonoperative treatment with strengthening exercises (nonoperative
group).
Functional outcomes were compared using a visual
analog scale (VAS) for pain, Lysholm knee score, Tegner activity scale,
and
patient subjective knee pain and satisfaction.
Radiological evaluations were performed using the Kellgren-Lawrence
classification
to evaluate osteoarthritic changes.
Results:
In terms of
clinical outcomes, meniscectomy did not provide better functional
improvement than nonoperative treatment. At
the final follow-up, the average VAS scores were
1.8 (range, 1-5) in the meniscectomy group and 1.7 (range, 1-4) in the
nonoperative
group (P = .675). The average Lysholm
knee scores at 2-year follow-up were 83.2 (range, 52-100) and 84.3
(range, 58-100) in the meniscectomy
and nonoperative groups, respectively (P
= .237). In addition, the average Tegner activity scale and subjective
satisfaction scores were not significantly different
between the 2 groups. Although most patients
initially had intense knee pain with mechanical symptoms, both groups
reported
a relief in knee pain, improved knee function,
and a high level of satisfaction with treatment (P < .05 for all values). Two patients in the meniscectomy group and 3 in the nonoperative group with Kellgren-Lawrence grade
1 progressed to grade 2 at the 2-year follow-up.
Conclusion:
There were
no significant differences between arthroscopic meniscectomy and
nonoperative management with strengthening exercises
in terms of relief in knee pain, improved knee
function, or increased satisfaction in patients after 2 years of
follow-up.
Source:
Ji-Hyeon Yim, Jong-Keun Seon, Eun-Kyoo Song, Jun-Ik Choi, Min-Cheol Kim, Keun-Bae Lee, Hyoung-Yeon Seo: A Comparative Study of
Meniscectomy and Nonoperative Treatment for Degenerative Horizontal Tears of
the Medial Meniscus. Presented at the 38th annual meeting of the AOSSM,
Baltimore, Maryland, July 2012.
