Degenerative Meniscal Tears Research Articles

Cochrane in CORR : Arthroscopic Surgery for Degenerative Knee Disease (Osteoarthritis Including Degenerative Meniscal Tears).

1McMaster University Medical Centre, Hamilton, ON, Canada M. E. Arakgi ✉, 293 Wellington Street N, Suite 110, Hamilton ON, L8L 8E7, Canada, Email: [email protected] A note from the Editor-in-Chief: We are pleased to publish the next installment of “Cochrane in CORR®”,our partnership between CORR®, The Cochrane Collaboration®, and McMaster University’s Evidence-Based Orthopaedics Group. In this column, researchers from McMaster University and other institutions will provide expert perspective on an abstract originally published in The Cochrane Library that we think is especially important. We welcome reader feedback on our editorials as we do on all of our columns and articles; please send your comments to[email protected]. (O'Connor D, Johnston RV, Brignardello-Petersen R, et al. Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears). Cochrane Database of Systematic Reviews. 2022, Issue 3. Art. No.: CD014328. DOI: 10.1002/14651858.CD014328.) The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®. Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library (http://www.thecochranelibrary.com) should be consulted for the most recent version of the review. Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This “Cochrane in CORR®” column refers to the abstract available at: DOI: 10.1002/14651858.CD014328.

How does arthroscopic surgery compare with placebo surgery for adults with osteoarthritis including degenerative meniscal tears?

How does arthroscopic surgery compare with placebo surgery for adults with osteoarthritis including degenerative meniscal tears?

Effectiveness of exercise versus arthroscopic partial meniscectomy plus exercise in the management of degenerative meniscal tears at 5-year follow-up: a systematic review and meta-analysis.

There are no meta-analytical data in the long term for comparing surgery and exercise for meniscal tear. The aim of this study is to compare the effectiveness of exercise versus arthroscopic partial meniscectomy (APM) plus exercise for degenerative meniscal tears(DMT) in knee function at 5-year follow-up. A systematic search of Medline, EMBASE, Web of Science, SciELO, SPORTDiscus, Scopus, and Cochrane Library was performed. The studies were included if they were randomized controlled trials performed in patients aged ≥ 18years with DMT, that compared physical therapy to APM at 5-year follow-up, and reported at least one outcome measure of knee function/disability. Risk of bias was analyzed with the Cochrane RoB-2 tool and certainty of evidence with GRADE recommendations. A random effects model meta-analysis was performed. 3743 articles were identified and 4 met the criteria. Three had low risk of bias and one had some concerns. There were no significant between-group differences, in within-group changes from baseline to 5-year, on the Knee Injury and Osteoarthritis Outcome Score pain (-2.28; 95% CI -5.41 to 0.84), symptoms (-0.24; 95% CI -4.13 to 3.64), activities of daily living (-2.16; 95% CI -6.16 to 1.83) and quality of life (-3.98; 95% CI -9.05 to 1.10). There was a significant difference in support of APM plus exercise for sport/recreation (-9.28; 95% CI -18.28 to -0.29). Leave-one-out sensitivity analysis revealed a non-significant difference in sport/recreation (-5.05; 95% CI -12.04 to 1.94). There were no differences in other patient-reported outcome measures. Moderate certainty of evidence suggests that the addition of APM to an exercise program adds no benefits in knee function at 5-year follow-up.

Classification, Risk Factors, Diagnoses, and Examination for Six-Type Meniscus Tears

The knee is the connection of the tibia and femur, which are two bones near to knees, and the menisci are in the knee joint shaped in two wedge pieces of fibrocartilage. Meniscus tears are considered the most common knee injuries and happen from acute trauma - like the fibrocartilage of meniscus tears, breaks, cracks, ruptures, or splits - or as the result of degenerative changes that happen over time. This study discussed the classification, risk factors, diagnoses, and examination for meniscus tears. The result shows that there are six common meniscus tears including bucket handle, flap, radial, degenerative, horizontal, and longitudinal meniscus tears. Risk factors of meniscus tears include age, gender, limb alignment, accidents, sports injuries, and osteoarthritis. Physical examinations and imaging examinations are commonly used techniques. Magnetic Resonance Imaging (MRI) is considered the most typical standard of testing meniscus tears. It can identify different types of meniscus tears and detect any associated damage to the ligaments, cartilage, and tendons.

Age alone does not affect the joint survivorship after arthroscopic partial meniscectomy for degenerative medial meniscus tears: a propensity-score matched survival analysis.

To evaluate the effect of age itself on the joint survivorship after arthroscopic partial meniscectomy (APM) for degenerative medial meniscus tears (DMTs). Patients undergoing APM for DMTs during 1999-2010 were retrospectively reviewed. The inclusion criteria were as follows: (1) DMTs identified on preoperative MRI scans, (2) no definite history of trauma, and (3) follow-up duration more than 5years. In evaluation of the joint survivorship, the endpoint was defined as conversion to arthroplasty (or realignment osteotomy) or progression to Kellgren-Lawrence grade 4. The study population was divided into older and younger groups by a cutoff age at which the difference in the joint survival rates was maximized, using a time-dependent receiver operating characteristic (ROC) curve. The two groups were then matched based on propensity scores. The joint survival rates were compared between the groups using Kaplan-Meier analysis, before and after propensity score matching (PSM). A total of 633 knees were included. The cutoff age was calculated as 60years. Before PSM, 239 knees were allocated to the older group (≥ 60years) and 394 knees to the younger group (< 60years). A significant difference in the joint survival rates was noted between the groups (log-rank test, p < 0.001). After PSM, 183 knees remained in each group. The difference in the survival rates was no more statistically significant (n.s.). The latest Lysholm scores of the older and the younger groups before PSM were 72.2 ± 20.8 and 79.9 ± 19.6, respectively (p < 0.001); however, the scores after PSM were 73.2 ± 20.3 and 77.4 ± 20.5, respectively (n.s.). Joint survivorship after APM was affected by other factors associated with the aging process, such as cartilage status and meniscal tear pattern, rather than age itself. Advanced age should not be the only reason for precluding APM in treatment of DMTs. APM is a viable option when treating DMTs in elderly patients if adopted with caution. According to this study, a surgeon should assess the age-related factors when he considers APM in elderly patients. III.

The Design and Characterization of a Strong Bio-Ink for Meniscus Regeneration.

The meniscus is vital to the mechanical function of the knee, while it is frequently harmed because it bears a heavy load. A strong bio-ink for meniscus regeneration was prepared for the future meniscal tissue engineering. The prepared bio-ink consists of poly (vinyl alcohol) and decellularized extracellular matrix (PVA/dECM). The mechanical properties and the rheological features were explored to evaluate the effects of freezing/thawing cycles and alkaline treatment process. The printability was verified using a three-dimensional printer. The endothelial cells were employed to assess the biocompatibility. Finally, a 12-week rabbit meniscus defect model was established to evaluate the meniscus regeneration capability. We found that the bio-ink by soaking in alkaline for 40 min and 20 freezing/thawing cycles demonstrated excellent mechanical properties. The Young's modulus reached 0.49 MPa and the stress limitation was 2.9 MPa. The results also showed good printability and biocompatibility of the proposed bio-ink in vitro. The PVA/dECM hydrogel healed the meniscus defect after 12 weeks of implantation. The articular cartilage and subchondral bone exhibited normal microstructure and composition. These results suggested that the PVA/dECM hydrogel could be a promising solution to repair meniscal lesions with preventive effects against degenerative meniscal tears and post-traumatic arthritis.

Cost-Effectiveness of Arthroscopic Partial Meniscectomy and Physical Therapy for Degenerative Meniscal Tear.

ObjectiveWe examined the cost‐effectiveness of treatment strategies for concomitant meniscal tear and knee osteoarthritis (OA) involving arthroscopic partial meniscectomy surgery and physical therapy (PT).MethodsWe used the Osteoarthritis Policy Model, a validated Monte Carlo microsimulation, to compare three strategies, 1) PT‐only, 2) immediate surgery, and 3) PT + optional surgery, for participants whose pain persists following initial PT. We modeled a cohort with baseline meniscal tear, OA, and demographics from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of arthroscopic partial meniscectomy versus PT. We estimated risks and costs of arthroscopic partial meniscectomy complications and accounted for heightened OA progression post surgery using published data. We estimated surgery use rates and treatment efficacies using MeTeOR data. We considered a 5‐year time horizon, discounted costs, and quality‐adjusted life‐years (QALYs) 3% per year and conducted sensitivity analyses. We report incremental cost‐effectiveness ratios.ResultsRelative to PT‐only, PT + optional surgery added 0.0651 QALY and $2,010 over 5 years (incremental cost‐effectiveness ratio = $30,900 per QALY). Relative to PT + optional surgery, immediate surgery added 0.0065 QALY and $3080 (incremental cost‐effectiveness ratio = $473,800 per QALY). Incremental cost‐effectiveness ratios were sensitive to optional surgery efficacy in the PT + optional surgery strategy. In the probabilistic sensitivity analysis, PT + optional surgery was cost‐effective in 51% of simulations at willingness‐to‐pay thresholds of both $50,000 per QALY and $100,000 per QALY.ConclusionFirst‐line arthroscopic partial meniscectomy has a prohibitively high incremental cost‐effectiveness ratio. Under base case assumptions, second‐line arthroscopic partial meniscectomy offered to participants with persistent pain following initial PT is cost‐effective at willingness‐to‐pay thresholds between $31,000 and $473,000 per QALY. Our analyses suggest that arthroscopic partial meniscectomy can be a high‐value treatment option for patients with meniscal tear and OA when performed following an initial PT course and should remain a covered treatment option.

Anatomical description and short-term follow up clinical results for ultrasound-guided injection of medial collateral ligament bursa: New conservative treatment option for symptomatic degenerative medial meniscus tear

BackgroundIn this study, we investigated newly developed ultrasound (US)-guided medial collateral ligament (MCL) bursa injection as a conservative therapy for symptomatic degenerative medial meniscal (MM) tears. We aimed to describe the anatomical target and precise technique of this injection, confirm its accuracy using fresh cadaveric knees, and then evaluate preliminary clinical outcomes. MethodsAnatomical studies were performed on three fresh cadavers. For the clinical study, 50 patients with medial knee joint pain without knee osteoarthritis were treated with US-guided MCL bursa injection. Severity of pain was assessed pre-injection, and 1 week and 4 weeks post-injection using a 0–10 numerical rating scale (NRS). Clinical success was defined as a full return to daily activities. All patients underwent magnetic resonance imaging (MRI) within 1 week of the first injection. Patients who underwent surgery within 12 months of the first injection were investigated as clinically unsuccessful cases, and MRI and arthroscopic findings were examined. ResultsCompared with pre-injection (6.8 ± 1.2), the average NRS score was significantly lower at 1 week (1.8 ± 2.0) and at 4 weeks (1.5 ± 1.7) post-injection (both P < 0.01). The primary clinical success rate was 76.0%, and injection-related adverse events were not observed. Nine patients underwent surgery (arthroscopic surgery for degenerative flap tear (n = 7) and high tibial osteotomy for medial meniscus posterior root tear and proximal tibial malalignment (n = 2)). ConclusionsUS-guided MCL bursa injection is safe, reproducible, and effective for symptomatic MM degenerative tears. However, US-guided injections of the MCL bursa may be ineffective for flap tears and posterior root tears.

Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears

There is a paucity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears. To compare the 5-year effectiveness of arthroscopic partial meniscectomy and exercise-based physical therapy on patient-reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscal tear. A noninferiority, multicenter randomized clinical trial was conducted in the orthopedic departments of 9 hospitals in the Netherlands. A total of 321 patients aged 45 to 70 years with a degenerative meniscal tear participated. Data collection took place between July 12, 2013, and December 4, 2020. Patients were randomly allocated to arthroscopic partial meniscectomy or 16 sessions of exercise-based physical therapy. The primary outcome was patient-reported knee function (International Knee Documentation Committee Subjective Knee Form (range, 0 [worst] to 100 [best]) during 5 years of follow-up based on the intention-to-treat principle, with a noninferiority threshold of 11 points. The secondary outcome was progression in knee osteoarthritis shown on radiographic images in both treatment groups. Of 321 patients (mean [SD] age, 58 [6.6] years; 161 women [50.2%]), 278 patients (87.1%) completed the 5-year follow-up with a mean follow-up time of 61.8 months (range, 58.8-69.5 months). From baseline to 5-year follow-up, the mean (SD) improvement was 29.6 (18.7) points in the surgery group and 25.1 (17.8) points in the physical therapy group. The crude between-group difference was 3.5 points (95% CI, 0.7-6.3 points; P < .001 for noninferiority). The 95% CI did not exceed the noninferiority threshold of 11 points. Comparable rates of progression of radiographic-demonstrated knee osteoarthritis were noted between both treatments. In this noninferiority randomized clinical trial after 5 years, exercise-based physical therapy remained noninferior to arthroscopic partial meniscectomy for patient-reported knee function. Physical therapy should therefore be the preferred treatment over surgery for degenerative meniscal tears. These results can assist in the development and updating of current guideline recommendations about treatment for patients with a degenerative meniscal tear. ClinicalTrials.gov Identifier: NCT01850719.

Arthroscopic Treatment of Degenerative Meniscal Tears and Sham Surgery or Physical Therapy—an Update on the ESCAPE Trial

Arthroscopic Treatment of Degenerative Meniscal Tears and Sham Surgery or Physical Therapy—an Update on the ESCAPE Trial

Current Controversies in Arthroscopic Partial Meniscectomy.

Given the continued controversy among orthopedic surgeons regarding the indications and benefits of arthroscopic partial meniscectomy (APM), this review summarizes the current literature, indications, and outcomes of partial meniscectomy to treat symptomatic meniscal tears. In patients with symptomatic meniscal tears, the location and tear pattern play a vital role in clinical management. Tears in the central white-white zone are less amenable to repair due to poor vascularity. Patients may be indicated for APM or non-surgical intervention depending on the tear pattern and symptoms. Non-surgical management for meniscal pathology includes non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), and intraarticular injections to reduce inflammation and relieve symptoms. There have been several landmark multicenter randomized controlled trials (RCTs) studying the outcomes of APM compared to PT or sham surgery in symptomatic degenerative meniscal tears. These most notably include the 2013 Meniscal Tear in Osteoarthritis Research (MeTeOR) Trial, the 2018 ESCAPE trial, and the sham surgery-controlled Finnish Degenerative Meniscal Lesion Study (FIDELITY), which failed to identify substantial benefits of APM over nonoperative treatment or even placebo surgery. Despite an abundance of literature exploring outcomes of APM for degenerative meniscus tears, there is little consensus among surgeons about the drivers of good outcomes following APM. It is often difficult to determine if the presenting symptoms are secondary to the meniscus pathology or the degenerative disease in patients with concomitant OA. A central tenet of managing meniscal pathology is to preserve tissue whenever possible. Most RCTs show that exercise therapy may be non-inferior to APM in degenerative tears if repair is not possible. Given this evidence, patients who fail nonoperative treatment should be counseled regarding the risks of APM before proceeding to surgical management.

Attachment Type, Thickness, and Volume of the Posterior Meniscofemoral Ligament and Meniscal Pathology.

Several studies have investigated the relationship between the thickness of the posterior meniscofemoral ligament (pMFL) and the presence of a discoid meniscus. We investigated the correlation between meniscal pathology and anatomic features of pMFL such as attachment type, thickness, and volume. We retrospectively evaluated 191 patients who underwent knee MRI. MR images were reviewed to assess the attachment type of the pMFL on the medial femoral condyle (high vs. low), the thickness of the pMFL, and the presence of a meniscal tear or a discoid meniscus. The pMFL volume was quantified by using three-dimensional (3D) segmentation software. The relationship between the frequency of medial or lateral meniscal tear and anatomic features of pMFL were analyzed using Chi-square, Fisher's exact, or Mann-Whitney U test. High type pMFLs had significantly greater thickness and volume than low type pMFLs (p < 0.001). Patients with degenerative lateral meniscal tear had significantly higher thickness and volume of the pMFL than patients with intact lateral meniscus (p < 0.05). The pMFL thickness and volume were not significantly related to traumatic lateral meniscal tear, medial meniscal tear, and discoid meniscus. High type pMFLs tended to be thicker and larger than low type pMFLs and higher thickness and volume of the pMFL was significantly related to the degenerative lateral meniscal tear. However, the attachment type of the pMFL itself was not significantly related to the lateral meniscal tear as well as the medial meniscal tear.

Association between knee pain location and abnormal imaging or arthroscopic findings: A systematic review.

Assessment of pain location is an essential component of the differential diagnosis of knee pain because pain location is thought to indicate pathology. Previous studies have questioned whether abnormal imaging findings are related to the presence of pain, but none has systematically reviewed the association between knee pain location and the location of abnormal imaging or arthroscopic findings. To systematically review the association between the location of knee pain and the location of abnormal imaging or arthroscopic findings. Databases were searched up to November 2021 for articles in English that investigated the association between pain location reported using pain mapping and the location of abnormal imaging or arthroscopic findings. Risk of bias was assessed with the modified Newcastle-Ottawa scale. Results were sub-grouped by pathology and data analysis was performed as appropriate. Among 7730 articles identified, 10 (n=2034 participants) met the inclusion criteria. Three sub-pathologies were evaluated: patellar tendinopathy (n=2), knee osteoarthritis (n=7), and degenerative meniscal tears (n=1). The primary analysis found poor sensitivity and specificity of patellar tendon hypoechogenic areas and local patellar tendon pain in adult (n=55) and adolescent athletes (n=114). The location of pain and the location of abnormal imaging findings was associated in 2 studies of knee osteoarthritis (n=166). Five articles reported no relationship (n=1563). No association was reported between the location of pain and the location of arthroscopic findings in degenerative meniscus tears (n=193). All articles included were rated at low risk of bias. Sensitivity and specificity of the presence of patellar tendon hypoechogenic areas and localised patellar tendon pain was poor. Pain location was not associated with the location of abnormal imaging findings in knee osteoarthritis or to abnormal arthroscopic findings in degenerative meniscus tears.

Implantation of Novel Meniscus Scaffold for Irreparable Meniscal Tear

Partial meniscectomy, which is generally used for the treatment of meniscal tears, can lead to knee joint osteoarthritis. To prevent this important complication, attempting to restore normal knee joint kinematics and biomechanical forces after partial meniscectomy is essential. Implantation of a meniscal scaffold can be useful in this regard, improving the function of the meniscus on knee joint biomechanics after partial meniscectomy. Use of meniscal scaffolds would have specific clinical merit for young patients who are at highest for developing knee joint osteoarthritis over time. Herein, we describe our novel bioabsorbable meniscal scaffold, fabricated with polyglycolic acid coated with polylactic acid/caprolactone, used after partial meniscectomy for degenerative and irreparable meniscal tears. The method of implantation of the scaffold will have a determinant effect on clinical outcomes. As the implementation technique by arthroscopy will be influenced by the stiffness and strength of the scaffold implant used, we provide a detailed description of our implantation technique, including a description of the pitfalls to consider in order to improve clinical outcomes.

Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears).

Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears).

Editor's Spotlight/Take 5: Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis.

Editor's Spotlight/Take 5: Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis.

An individualized decision between physical therapy or surgery for patients with degenerative meniscal tears cannot be based on continuous treatment selection markers: a marker-by-treatment analysis of the ESCAPE study

PurposeMarker-by-treatment analyses are promising new methods in internal medicine, but have not yet been implemented in orthopaedics. With this analysis, specific cut-off points may be obtained, that can potentially identify whether meniscal surgery or physical therapy is the superior intervention for an individual patient. This study aimed to introduce a novel approach in orthopaedic research to identify relevant treatment selection markers that affect treatment outcome following meniscal surgery or physical therapy in patients with degenerative meniscal tears.MethodsData were analysed from the ESCAPE trial, which assessed the treatment of patients over 45 years old with a degenerative meniscal tear. The treatment outcome of interest was a clinically relevant improvement on the International Knee Documentation Committee Subjective Knee Form at 3, 12, and 24 months follow-up. Logistic regression models were developed to predict the outcome using baseline characteristics (markers), the treatment (meniscal surgery or physical therapy), and a marker-by-treatment interaction term. Interactions with p < 0.10 were considered as potential treatment selection markers and used these to develop predictiveness curves which provide thresholds to identify marker-based differences in clinical outcomes between the two treatments.ResultsPotential treatment selection markers included general physical health, pain during activities, knee function, BMI, and age. While some marker-based thresholds could be identified at 3, 12, and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times.ConclusionThis novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. However, this study may serve as an exemplar for other orthopaedic trials to investigate the heterogeneity in treatment effect. It will help clinicians to quantify the additional benefit of one treatment over another at an individual level, based on the patient’s baseline characteristics.Level of evidenceII.

Proteomics Profiling of Human Synovial Fluid Suggests Increased Protein Interplay in Early-Osteoarthritis (OA) That Is Lost in Late-Stage OA

The underlying molecular mechanisms in osteoarthritis (OA) development are largely unknown. This study explores the proteome and the pairwise interplay of proteins in synovial fluid from patients with late-stage knee OA (arthroplasty), early knee OA (arthroscopy due to degenerative meniscal tear), and from deceased controls without knee OA. Synovial fluid samples were analyzed using state-of-the-art mass spectrometry with data-independent acquisition. The differential expression of the proteins detected was clustered and evaluated with data mining strategies and a multilevel model. Group-specific slopes of associations were estimated between expressions of each pair of identified proteins to assess the co-expression (i.e., interplay) between the proteins in each group. More proteins were increased in early-OA versus controls than late-stage OA versus controls. For most of these proteins, the fold changes between late-stage OA versus controls and early-stage OA versus controls were remarkably similar suggesting potential involvement in the OA process. Further, for the first time, this study illustrated distinct patterns in protein co-expression suggesting that the interplay between the protein machinery is increased in early-OA and lost in late-stage OA. Further efforts should focus on earlier stages of the disease than previously considered.

Muscle Strength and Osteoarthritis Progression After Surgery or Exercise for Degenerative Meniscal Tears: Secondary Analyses of a Randomized Trial.

To evaluate muscle strength changes following partial meniscectomy or exercise therapy for degenerative meniscal tears and the relationship between baseline muscle strength and osteoarthritis progression. Secondary analysis of a randomized trial (n = 140 participants). Isokinetic quadriceps and hamstrings strength (peak torque [Nm/kg] and total work [J/kg]) were assessed at baseline, 3-month, 12-month, and 5-year follow-up. Between-group differences were analyzed using intent-to-treat linear mixed models. The relationship between baseline muscle strength and osteoarthritis progression (Kellgren/Lawrence ≥1 grade increase) were assessed using logistic regression models. We found statistically significant between-group differences favoring exercise therapy at 3 months (quadriceps -0.30 Nm/kg [95% confidence interval (95% CI) -0.40, -0.20]; hamstrings -0.10 Nm/kg [95% CI -0.15, -0.04]) and 12 months (quadriceps -0.13 Nm/kg [95% CI -0.23, -0.03]; hamstrings -0.08 Nm/kg [95% CI -0.14, -0.03]). At 5 years, between-group differences were -0.10 Nm/kg (95% CI -0.21, 0.01) for quadriceps and -0.07 Nm/kg (95% CI -0.13, -0.01) for hamstrings. Quadriceps muscle weakness at baseline was associated with knee osteoarthritis progression over 5 years, with adjusted odds ratio of 1.40 for every 0.2 Nm/kg decrease (95% CI 1.15, 1.71). The adjusted odds ratio for hamstrings was 1.14 (95% CI 0.97, 1.35) for every 0.1 Nm/kg decrease. Exercise therapy was effective in improving muscle strength at 3- and 12-month follow-up compared to partial meniscectomy, but the effect was attenuated at 5 years. Quadriceps muscle weakness at baseline was associated with higher odds of osteoarthritis progression over 5 years.

Aquatic vs. land-based exercise after arthroscopic partial meniscectomy in middle-aged active patients with a degenerative meniscal tear: A randomized, controlled study

BackgroundAwareness of the value of aquatic exercise (AE) in the postoperative rehabilitation has increased, and several inherent advantages of AE, such as adjustment of both resistance and muscle strengthening parameters makes good rationale for its inclusion in postoperative rehabilitation. This study aimed to determine and compare the benefits of AE and land-based exercise (LBE) on pain, functionality, and quality of life after arthroscopic partial meniscectomy (APM). MethodsThis randomized controlled study included 30 middle-aged (35–50), physically active patients who were randomized into LBE (n = 15) and AE (n = 15) groups after APM for a degenerative meniscal tear. Visual analogue scale (VAS), Short Form-36 (SF-36), single-leg hop test and Lysholm questionnaire scores in addition to isokinetic muscle strength values were evaluated at baseline, at fourth week immediately after cessation of exercise program and at eighth week follow-up visits. The exercise sessions were conducted in 1-h sessions per day, three days a week for a total of four weeks. ResultsSignificant improvement was observed in the VAS, single-leg hop test, Lysholm questionnaire, and most of SF-36 subscale scores in both groups at both fourth and eighth follow-ups. Isokinetic dynamometer revealed significant improvement in the peak torque values for extension at angular velocities of 60° and 180° at both follow-ups in the AE group. LBE group showed significant improvement in the peak torque value for extension only at an angular velocity of 60° only at fourth week follow-up. There was no significant difference between groups for any of these parameters at any of the follow-ups. ConclusionBoth AE and LBE programs had significantly improved pain, function, isokinetic muscle strength, and quality of life in patients after APM. Either type of exercise is essential as part of the rehabilitation protocol for good clinical outcomes after APM and should not be neglected (level II). ClinicalTrials registration numberNCT04925726.