Medical exercise therapy alone versus arthroscopic partial meniscectomy followed by medical exercise therapy for degenerative meniscal tear: a systematic review and meta-analysis of randomized controlled trials

Jianxiong Ma,Xinlong Ma,Hengting Chen,Yuhong Cui,Aifeng Liu

doi:10.1186/s13018-020-01741-3

Abstract

ObjectiveTo explore if medical exercise therapy (MET) alone is comparable to arthroscopic partial meniscectomy (APM) followed by MET for knee pain, activity level, and physical function in middle-aged patients with degenerative meniscal tear (DMT) by a systematic review and meta-analysis of randomized controlled trials (RCTs).MethodA systematic search of electronic databases (PubMed, the Cochrane Library, Embase, and Web of Science) was conducted to retrieve RCTs comparing MET+APM with MET alone for DMT. Risk of bias of the studies was evaluated. Outcomes assessed were pain relief, physical function, and activity level.ResultsA total of 6 RCTs containing 879 patients were included. After pooling the data of 5 researches, we found small significant differences support the APM + MET group for pain control assessed by Knee injury and Osteoarthritis Outcome Score (KOOS) at 2 to 3 months (p = 0.004) and at 6 months (p = 0.04). And there were statistically improvements in APM + MET at 6 months compared with MET alone when changing measurement to visual analog scale (VAS) (p = 0.0003). Our analysis also found small significant differences favor the APM followed by MET group for physical function both at 2 to 3 months (p = 0.01, KOOS and Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC; and P = 0.40, Lysholm Knee Scoring Scale) and at 6 months (p = 0.01, KOOS and WOMAC).ConclusionWe found favorable results of APM + MET up to 6 months for pain control and physical function. However, there were no differences at longer follow-up. The clinical applicability of APM + MET compared with MET should be interpreted carefully, and the potential of MET to treat DMT should be valued.

Highlights

We found favorable results of arthroscopic partial meniscectomy (APM) + medical exercise therapy (MET) up to 6 months for pain control and physical function
The clinical applicability of APM + MET compared with MET should be interpreted carefully, and the potential of MET to treat degenerative meniscal tear (DMT) should be valued
We found that APM followed by structured MET was more effective compared to MET alone in terms of visual analogue scale (VAS) score, Knee injury and Osteoarthritis Outcome Score (KOOS) Pain dimension, Lysholm Knee Scoring Scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and KOSS function score within 6 months

Summary

Introduction

The menisci of the knee (medial and lateral) are wedgeshaped semilunar disks which are consisted of fibrocartilage interposed between the condyles of the femur and the tibia [1]. Meniscal tissue is mainly composed of water and type I collagen fibers, which contributes to absorb the energy by converting axial loading forces across the joint into hoop stresses within the tissue. The quality of menisci degenerates with aging: the cellularity, collagen content, and actual amount of glycosaminoglycans diminish, whereas the water content grows [2, 3]. This leads to the meniscus of older individuals that is more prone to acute injuries and chronic damage. Affected individuals clinically present with knee pain, swelling, and impaired function [5]

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