Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up

Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM · BMJ

The between-group difference in KOOS4 change at two years was 0.9 points (95% CI -4.3 to 6.1; P=0.72). Thigh muscle strength improved in the exercise group at three months (P<=0.004). Thirteen of 70 participants (19%) allocated to exercise crossed over to surgery between 3 and 16 months, with no additional benefit; no serious adverse events occurred in either group.

Population

140 adults, mean age 49.5 years, with an MRI-verified degenerative medial meniscal tear; 96% had no definitive radiographic osteoarthritis. Two Norwegian hospitals and two physiotherapy clinics

Intervention

12 weeks of supervised exercise therapy alone

Comparator

Arthroscopic partial meniscectomy alone

Limitations

Open-label, so expectation effects are unblinded in both directions, and only 43 of 70 (61%) in the exercise arm completed the programme with satisfactory or excellent compliance. The strength finding is the one clean separation, and it favours the arm that trained.