title: Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up.
abstract: OBJECTIVE
  The aim of this prospective randomized intervention study was to evaluate the outcome at a 2 and 5 year follow-up whether combined arthroscopic surgery followed by exercise therapy was superior to the same exercise therapy alone when treating non-traumatic, degenerative medial meniscal tears.
  
  
  METHODS
  Ninety-six middle-aged patients with MRI-verified degenerative medial meniscus tear and radiographic osteoarthritis grade ≤1 (Ahlbäck) participated in the study. Radiographic examination was done before randomization and after 5 years. The patients were randomly assigned to either arthroscopic treatment followed by exercise therapy for 2 months or to the same exercise therapy alone. At the start of the study and at the follow-ups at 24 and 60 months the patients answered three questionnaires KOOS, Lysholm Knee Scoring Scale and Tegner Activity Scale and made pain ratings on the Visual Analogue Scale (VAS).
  
  
  RESULTS
  Both groups showed highly significant clinical improvements from baseline to the follow-ups at 24 and 60 months on all subscales of KOOS, Lysholm Knee Scoring Scale and VAS (p < 0.0001). No group differences were found at any of the testing occasions. One third of the patients that were treated with exercise therapy alone did not feel better after the treatment but were improved after arthroscopic surgery. According to radiographic findings two patients from each group had a slight progression of their osteoarthritis after 5 years.
  
  
  CONCLUSIONS
  The findings indicate that arthroscopic surgery followed by exercise therapy was not superior to the same exercise therapy alone for this type of patients. Consequently, exercise therapy can be recommended as initial treatment. However, one third of the patients from the exercise group still had disabling knee symptoms after exercise therapy but improved to the same level as the rest of the patients after arthroscopic surgery with partial meniscectomy.
  
  
  METHODS
  I.
authors.affiliation: Department of Physiotherapy, Herrlin Invest, Tunavägen 8, 181 65, Lidingö, Sweden. sylvia.herrlin@tele2.se
authors.forename: Sylvia V
authors.initials: SV
authors.lastname: Herrlin
authors.forename: Peter O
authors.initials: PO
authors.lastname: Wange
authors.forename: Gunilla
authors.initials: G
authors.lastname: Lapidus
authors.forename: Maria
authors.initials: M
authors.lastname: Hållander
authors.forename: Suzanne
authors.initials: S
authors.lastname: Werner
authors.forename: Lars
authors.initials: L
authors.lastname: Weidenhielm
mesh_terms: D001182:Arthroscopy; D002357:Cartilage Diseases / Q000534:rehabilitation / Q000601:surgery*; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000534:rehabilitation / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome