A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus.

Yim JH, Seon JK, Song EK, Choi JI, Kim MC, Lee KB, Seo HY.

Source

Department of Orthopedic Surgery, Gwangju Hyundae Hospital, Gwangju, Korea.

Am J Sports Med July 2013 41 1565–1570

Level of Study: Level 2 Randomised Control Trial

Aims of the Study:

The study was conducted to observe whether menisectomy was useful for the treatment of degenerative meniscal tears. 108 patients with degenerative meniscal tears of the posterior horn of meniscus were randomized to receive menisectomy or nonoperative treatment in the form of analgeiscs, muscle relaxants, physiotherapy and exercises. The parameters evaluated were Visual Analog Score, Lysholm Knee Score, Tegner Activity Index, subjective satisfaction scores

MATERIALS AND METHODS(PICO)

1. POPULATION

108 patients were selected who had knee pain and tear of the posterior horn of medial meniscus.

With RANGE – 43 to 62yrs and MEDIAN AGE – 56.8yrs

n= 102 patients who completed follow up

2. INTERVENTION(n= 54 patients)

The meniscectomy group of patients underwent arthroscopic meniscectomy using a 5.5mm 30degree arthroscope and a pressure controlled irrigation system and a limited debridement of the articular surface lesion was performed. The patients were on NSAIDs and analgesics for the 1^st two weeks and they underwent a home exercise program for 8 weeks.

3. CONTROL(n= 54 patients)

The non-operative group on the other hand were prescribed analgesics, NSAIDs or muscle relaxants for the first two weeks, followed by supervised exercises to improve muscle strength, endurance and flexibility (60min each,3times a week for 3 weeks) and then home exercise program for 8 weeks consisting of isotonic and isometric muscle exercises.

4. OUTCOME MEASUREMENT

Outcomes were visual analog scale (VAS) pain, Lysholm knee score, Tegner activity scale and patient subjective knee pain and satisfaction. Kellgren-Lawrence classification was used to radiologically evaluate the osteoarthritic changes.

RESULTS

Knee pain at high flexion (92%) and tenderness at the posteromedial joint line were the most common symptoms reported by the patients before the treatment was initiated.
Both the groups demonstrated similar VAS score at 2 year follow up. The symptoms showed improvement in the meniscectomy group while they lasted longer in the non-operative group.
Among the patients in the meniscectomy group – knee pain with mechanical symptoms were completely relieved in 34, improved in 13 and remained in 3 at 2-year follow up. While in the non-operative group – symptoms were completely relieved in 35, improved in 12 and remained in 5 patients.
In the non-operative group 17 patients were very satisfied, 29 satisfied and 6 not satisfied. On the other hand among the meniscectomy group of patients, 18 patients were very satisfied,28 satisfied and 4 not satisfied.
Lyholm scores showed improvement in both groups at 2-year follow up with average scores of 83.2 and 84.3 in the meniscectomy and non-operative groups of patients respectively. There was a difference favouring meniscectomy noticed at the 3^rd month (0.031)
At 2 years the Tegner scores improved in the meniscectomy group from 4.2 to 5.1 and from 4.1 to 4.9 in the non-operatve group. No significant differences wer noted between the treatments(P-0.522)
OA progression by >1 grade was observed in 2 patients in meniscectomy group and 3 in the non-operative group at 2yearsof follow-up. The difference compared to pre-treatment values were not significant (p>.05)

CONCLUSION:

There were no significant differences between arthroscopic meniscectomy and nonoperative management with strengthening exercises in terms of relief in knee pain, improved knee function, or increased satisfaction in patients after 2 years of follow-up.
Complications of surgery and Cost effectiveness must be weighed before considering patients candidates for surgery

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