Comparative pilot study
Medical exercise therapy, and not arthroscopic surgery, resulted in decreased depression and anxiety in patients with degenerative meniscus injury

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Summary

The purpose of this pilot study was to compare the effectiveness of conservative therapy involving medical exercise therapy (MET) versus arthroscopic surgery in patients with knee pain, with MRI-verified degenerative meniscus. The patients were randomly assigned either to MET (n = 9) or to arthroscopic surgery (n = 8). Patients receiving MET had 3 treatments a week for 3 months, a total of 36 treatments. The arthroscopy consisted of meniscectomy with no structured conservative therapy after surgery. Assessment of pain, function, anxiety and depression were performed at inclusion and after 3 months. At the end of treatment, which was 3 months after inclusion, there were no statistical differences between the two groups regarding pain and function. However, anxiety and depression were significantly reduced in the MET group compared with the patients receiving arthroscopic surgery. Bearing in mind the low number of included patients in this pilot study, arthroscopy was found to be no better than MET regarding knee pain and overall daily function. The results from this pilot study are similar to other clinical studies, thereby demonstrating that conservative therapy is just as effective as surgery.

Section snippets

Background

Knee pain is one of the most common symptoms in middle age, and a degenerative meniscus is a normal finding in this patient category (Murphy et al., 2008). Affected individuals clinically present with knee pain, stiffness, swelling and impaired function (Ericsson et al., 2006). These symptoms can be part of early osteoarthritis (Englund et al., 2009), as meniscal tears are common and a frequent incidental finding on knee MR imaging of middle-aged people. The surgical resection of

Design

Ethical approval was acquired from the Human Subject Review Committee (Trondheim, Norway), and all participants gave their written consent to participate in the study after receiving written information about the study. The tester was not blinded to which intervention the patient received. The subjects were informed about the length of the study, test procedures and treatment procedures, and were told that they could withdraw from the study at any time. Baseline data for all of the included

Results

All of the allocated patients completed the study, with the flow of the subjects throughout the study presented in Fig. 1. There were no participants lost to the follow-up assessments, and the baseline characteristics of the study population are outlined in Table 1.

All possible efforts were made to enhance compliance and adherence with the program. On average, the subjects in the MET group completed 84% (range 77–92%) of the rehabilitation program.

Discussion

The purpose of the present pilot study was to compare the clinical effects of high-repetition, high-dosage medical exercise therapy (MET) versus surgery for middle-aged patients with a non-traumatic meniscus tear. At the end of treatment 3 months after inclusion, there were no differences between the two groups regarding pain and function. However, there was a significant difference between groups with less depression and anxiety in the MET group.

This is an important finding because anxiety and

Conclusion

With the low number of participants in mind for patients with non-traumatic meniscal injury, arthroscopy was not superior to medical exercise therapy alone in terms of knee pain and overall daily function. This study therefore indicates a need for further studies to elaborate the effect of medical exercise therapy compared to arthroscopy surgery for patients with chronic knee pain and verified degenerative meniscus. Further research should also be completed as randomized controlled trials that

Conflicts of interest

None.

Acknowledgments

The authors wish to thank physiotherapists, Lasse Haugerud and Eivind Selven, for their contribution in interventions for the patients.

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