title: Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up.
abstract: OBJECTIVE
  To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears.
  
  
  METHODS
  Randomised controlled superiority trial.
  
  
  METHODS
  Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway.
  
  
  METHODS
  140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis.
  
  
  METHODS
  12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone.
  
  
  METHODS
  Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months.
  
  
  RESULTS
  No clinically relevant difference was found between the two groups in change in KOOS4 at two years (0.9 points, 95% confidence interval -4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit.
  
  
  CONCLUSIONS
  The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.Trial registration www.clinicaltrials.gov (NCT01002794).
authors.affiliation: Department of Orthopaedic Surgery, Martina Hansens Hospital, PO box 823, N-1306 Sandvika, Norway nina.kise@mhh.no.
authors.forename: Nina Jullum
authors.initials: NJ
authors.lastname: Kise
authors.affiliation: Norwegian Research Centre for Active Rehabilitation, Oslo, Norway Division of Orthopaedic Surgery, Oslo University Hospital, Norway Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
authors.forename: May Arna
authors.initials: MA
authors.lastname: Risberg
authors.affiliation: Norwegian Research Centre for Active Rehabilitation, Oslo, Norway.
authors.forename: Silje
authors.initials: S
authors.lastname: Stensrud
authors.affiliation: Department of Orthopaedics, Clinical Sciences Lund, Lund University, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Ranstam
authors.affiliation: Division of Orthopaedic Surgery, Oslo University Hospital, Norway Faculty of Medicine, University in Oslo Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Engebretsen
authors.affiliation: Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: Ewa M
authors.initials: EM
authors.lastname: Roos
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods*; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D009664:Norway; D010146:Pain; D010147:Pain Measurement; D011788:Quality of Life; D012720:Severity of Illness Index; D016037:Single-Blind Method; D000070600:Tibial Meniscus Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome