Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2007

01.04.2007 | Knee

Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial

verfasst von: Sylvia Herrlin, Maria Hållander, Peter Wange, Lars Weidenhielm, Suzanne Werner

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 4/2007

Einloggen, um Zugang zu erhalten

Abstract

In this prospective randomised study two treatments after non-traumatic medial meniscal tear diagnosed with radiological examination and magnetic resonance imaging were compared; arthroscopic partial meniscectomy followed by supervised exercise or supervised exercise alone. The aim was to evaluate knee function and physical activity. Ninety patients (mean age 56 years) were evaluated using the Knee Injury and Osteoarthritis Outcome Score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and a Visual Analogue Scale for knee pain prior to the intervention, after 8 weeks of exercise and after 6 months. According to the outcome scores arthroscopic partial medial meniscectomy combined with exercise did not lead to greater improvement than exercise alone. After the intervention both groups reported decreased knee pain, improved knee function and a high satisfaction (P < 0.0001). Forty-one per cent of the patients returned to their pre-injury activity level after 6 months. In conclusion, when evaluated with outcome scores, arthroscopic partial medial meniscectomy followed by supervised exercise was not superior to supervised exercise alone in terms of reduced knee pain, improved knee function and improved quality of life.
Literatur
1.
Zurück zum Zitat Aagaard H, Verdonk R (1999) Function of the normal meniscus and consequences of meniscal resection. Scand J Med Sci Sports 9:134–140PubMedCrossRef Aagaard H, Verdonk R (1999) Function of the normal meniscus and consequences of meniscal resection. Scand J Med Sci Sports 9:134–140PubMedCrossRef
2.
Zurück zum Zitat Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiologica 277(Suppl 277):7–72 Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiologica 277(Suppl 277):7–72
3.
4.
Zurück zum Zitat American College of Sports Medicine (ACSM) (2002) Progression models in resistance training for healthy adults. Med Sci Sports Exerc 34:364–380 American College of Sports Medicine (ACSM) (2002) Progression models in resistance training for healthy adults. Med Sci Sports Exerc 34:364–380
5.
Zurück zum Zitat Augustsson J (2001) Styrketräning vid rehabilitering. Sv Idr Forskn 3:65–71 Augustsson J (2001) Styrketräning vid rehabilitering. Sv Idr Forskn 3:65–71
6.
Zurück zum Zitat Bengtsson J, Möllborg J, Werner S (1996) A study for testing the sensitivity and reliability of the Lysholm knee scoring scale. Knee Surg, Sports Traumatol, Arthrosc 4:27–31CrossRef Bengtsson J, Möllborg J, Werner S (1996) A study for testing the sensitivity and reliability of the Lysholm knee scoring scale. Knee Surg, Sports Traumatol, Arthrosc 4:27–31CrossRef
7.
Zurück zum Zitat Bhattacharyya T et al (2003) The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Joint Surg Am 85:4–9PubMed Bhattacharyya T et al (2003) The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Joint Surg Am 85:4–9PubMed
8.
Zurück zum Zitat Burks RT, Metcalf MH, Metcalf RW (1997) Fifteen-year follow-up of arthroscopic partial meniscectomy. J Arthroscopic Rel Surg 13:673–679CrossRef Burks RT, Metcalf MH, Metcalf RW (1997) Fifteen-year follow-up of arthroscopic partial meniscectomy. J Arthroscopic Rel Surg 13:673–679CrossRef
9.
Zurück zum Zitat Börjesson M, Robertson E, Weidenhielm L, Mattsson E, Olsson E (1996) Physiotherapy in knee osteoarthrosis: effect on pain and walking. Physiother Res Int 1:89–97PubMed Börjesson M, Robertson E, Weidenhielm L, Mattsson E, Olsson E (1996) Physiotherapy in knee osteoarthrosis: effect on pain and walking. Physiother Res Int 1:89–97PubMed
10.
Zurück zum Zitat Börjesson M, Karlsson J, Mannheimer C (2001) Mindre ont med motion. Läkartidningen 5:1786–1791 Börjesson M, Karlsson J, Mannheimer C (2001) Mindre ont med motion. Läkartidningen 5:1786–1791
11.
Zurück zum Zitat Cameron ML, Briggs KK, Steadman JR (2003) Reproducibility and reliability of the Outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 31:83–86PubMed Cameron ML, Briggs KK, Steadman JR (2003) Reproducibility and reliability of the Outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 31:83–86PubMed
12.
Zurück zum Zitat Chatain F, Robinson AH, Adeleine P, Chambat P, Neyret P (2001) The natural history of the knee following arthroscopic medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 9(1):15–18PubMedCrossRef Chatain F, Robinson AH, Adeleine P, Chambat P, Neyret P (2001) The natural history of the knee following arthroscopic medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 9(1):15–18PubMedCrossRef
13.
Zurück zum Zitat Desai VV, Ackroyd CE (2000) Resection of degenerate menisci—is it useful? Knee 7(3):179–182PubMedCrossRef Desai VV, Ackroyd CE (2000) Resection of degenerate menisci—is it useful? Knee 7(3):179–182PubMedCrossRef
14.
Zurück zum Zitat Englund M, Roos EM, Roos HP, Lohmander LS (2001) Patient-relevant outcomes fourteen years after menisectomy: influence of type of meniscal tear and size of resection. Rheumatology 40:631–639PubMedCrossRef Englund M, Roos EM, Roos HP, Lohmander LS (2001) Patient-relevant outcomes fourteen years after menisectomy: influence of type of meniscal tear and size of resection. Rheumatology 40:631–639PubMedCrossRef
15.
Zurück zum Zitat Feigenbaum M, Pollock M (1999) Prescription of resistance training for health and disease. Med Sci Sports Exerc 31:38–45PubMedCrossRef Feigenbaum M, Pollock M (1999) Prescription of resistance training for health and disease. Med Sci Sports Exerc 31:38–45PubMedCrossRef
16.
Zurück zum Zitat Fisher NM, Pendergast DR (1997) Reduced muscle function in patients with osteoarthritis. Scan J Rehab Med 29:213–221 Fisher NM, Pendergast DR (1997) Reduced muscle function in patients with osteoarthritis. Scan J Rehab Med 29:213–221
17.
Zurück zum Zitat Goodwin PC, Morrissey MC (2003) Physical therapy after arthroscopic partial menisectomy: is it effective? Exerc Sport Sci Rev 31(2):85–90PubMedCrossRef Goodwin PC, Morrissey MC (2003) Physical therapy after arthroscopic partial menisectomy: is it effective? Exerc Sport Sci Rev 31(2):85–90PubMedCrossRef
18.
Zurück zum Zitat Goodwin PC, Morrissey MC, Omar RZ, Brown M, Southall K, McAuliffe TB (2003) Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy. Phys Ther 6:521–535 Goodwin PC, Morrissey MC, Omar RZ, Brown M, Southall K, McAuliffe TB (2003) Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy. Phys Ther 6:521–535
19.
Zurück zum Zitat Goodyear-Smith F, Arroll B (2001) Rehabilitation after arthroscopic meniscectomy: a critical review of the clinical trials. Int Orthop 24:350–353PubMedCrossRef Goodyear-Smith F, Arroll B (2001) Rehabilitation after arthroscopic meniscectomy: a critical review of the clinical trials. Int Orthop 24:350–353PubMedCrossRef
20.
Zurück zum Zitat Hamberg P, Gillquist J (1984) Knee function after arthroscopic meniscectomy. A prospective study. Acta Orthop Scand 55:172–175PubMedCrossRef Hamberg P, Gillquist J (1984) Knee function after arthroscopic meniscectomy. A prospective study. Acta Orthop Scand 55:172–175PubMedCrossRef
21.
22.
Zurück zum Zitat Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMed Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMed
23.
Zurück zum Zitat Mangione KK, McCully K, Gloviak A, Lefebvre I, Hofman M, Craik R (1999) The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. J Gerontol A Biol Sci Med Sci 54:184–190 Mangione KK, McCully K, Gloviak A, Lefebvre I, Hofman M, Craik R (1999) The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. J Gerontol A Biol Sci Med Sci 54:184–190
24.
Zurück zum Zitat Marx RG et al (2001) Reliability, validity and responsiveness of four knee outcome scales for athletic patients. J Bone Surg (Am) 83:1459–1469 Marx RG et al (2001) Reliability, validity and responsiveness of four knee outcome scales for athletic patients. J Bone Surg (Am) 83:1459–1469
25.
Zurück zum Zitat Marx RG et al (2005) Multirater agreement of arthroscopic grading of knee articular cartilage. Am J Sports Med 33:1654–1657PubMedCrossRef Marx RG et al (2005) Multirater agreement of arthroscopic grading of knee articular cartilage. Am J Sports Med 33:1654–1657PubMedCrossRef
26.
Zurück zum Zitat Matsusue Y, Thomson NL (1996) Arthroscopic partial medial meniscectomy in patients over 40 years old: a 5- to 11-year followed-up study. Arthroscopy 12:39–44PubMedCrossRef Matsusue Y, Thomson NL (1996) Arthroscopic partial medial meniscectomy in patients over 40 years old: a 5- to 11-year followed-up study. Arthroscopy 12:39–44PubMedCrossRef
27.
Zurück zum Zitat Matthews P, St-Pierre DM (1996) Recovery of muscle strength following arthroscopic meniscectomy. J Orthop Sports Phys Ther 23(1):18–26PubMed Matthews P, St-Pierre DM (1996) Recovery of muscle strength following arthroscopic meniscectomy. J Orthop Sports Phys Ther 23(1):18–26PubMed
28.
Zurück zum Zitat Menetrey J, Siegrist O, Fritschy D (2002) Medial meniscectomy in patients over the age of fifty: a six year follow-up study. Swiss Surg 8:113–119PubMedCrossRef Menetrey J, Siegrist O, Fritschy D (2002) Medial meniscectomy in patients over the age of fifty: a six year follow-up study. Swiss Surg 8:113–119PubMedCrossRef
29.
Zurück zum Zitat Moffet H, Richards CL, Maloin F, Bravo G, Paradis G (1994) Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: results of a randomized controlled study. Arch Phys Med Rehabil 75:415–426PubMedCrossRef Moffet H, Richards CL, Maloin F, Bravo G, Paradis G (1994) Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: results of a randomized controlled study. Arch Phys Med Rehabil 75:415–426PubMedCrossRef
30.
Zurück zum Zitat Muellner T, Nikolie A, Vécsei V (1999) Recommendations for the diagnosis of traumatic meniscal injuries in athletes. Sports Med 27(5):337–345PubMedCrossRef Muellner T, Nikolie A, Vécsei V (1999) Recommendations for the diagnosis of traumatic meniscal injuries in athletes. Sports Med 27(5):337–345PubMedCrossRef
31.
Zurück zum Zitat Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg 43B:752–757 Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg 43B:752–757
32.
Zurück zum Zitat Pedersen BK, Saltin B (2006) Evidence for prescribing exercise as therapy in chronic disease. Scan J Med Sci Sports 16(Suppl1):3–63CrossRef Pedersen BK, Saltin B (2006) Evidence for prescribing exercise as therapy in chronic disease. Scan J Med Sci Sports 16(Suppl1):3–63CrossRef
33.
Zurück zum Zitat Petersson IF, Boegard T, Saxne T, Silman AJ, Svensson B (1997) Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35–54 years with chronic knee pain. Ann Rheum Dis 56(8):493–496PubMed Petersson IF, Boegard T, Saxne T, Silman AJ, Svensson B (1997) Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35–54 years with chronic knee pain. Ann Rheum Dis 56(8):493–496PubMed
34.
Zurück zum Zitat Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP (1995) Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med 23(2):240–244PubMed Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP (1995) Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med 23(2):240–244PubMed
35.
Zurück zum Zitat Rangger C, Kathrein A, Klestil T, Gloetzer W (1997) Partial meniscectomy and osteoarthritis. Implications for treatment of athletes. Sports Med 23(1):61–68PubMedCrossRef Rangger C, Kathrein A, Klestil T, Gloetzer W (1997) Partial meniscectomy and osteoarthritis. Implications for treatment of athletes. Sports Med 23(1):61–68PubMedCrossRef
36.
Zurück zum Zitat Renström PAF (1995) Knee pain in tennis players. Clin Sports Med 14(1):163–175PubMed Renström PAF (1995) Knee pain in tennis players. Clin Sports Med 14(1):163–175PubMed
37.
Zurück zum Zitat Risberg MA, Holm I, Steen H, Beynnon BD (1999) Sensitivity to changes over time for the IKDC form, the Lysholm score and the Cincinnati knee score: a prospective study of 120 ACL reconstructed patients with a 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 7(3):152–159PubMedCrossRef Risberg MA, Holm I, Steen H, Beynnon BD (1999) Sensitivity to changes over time for the IKDC form, the Lysholm score and the Cincinnati knee score: a prospective study of 120 ACL reconstructed patients with a 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 7(3):152–159PubMedCrossRef
38.
Zurück zum Zitat Rockborn P (2000) Clinical and radiographic outcome of meniscectomy and meniscus repair in the stable knee. Thesis. University of Linköping, Sweden Rockborn P (2000) Clinical and radiographic outcome of meniscectomy and meniscus repair in the stable knee. Thesis. University of Linköping, Sweden
39.
Zurück zum Zitat Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee injury and osteoarthritis outcome score (KOOS)—validation of Swedish version. Scand J Med Sci Sports 8:439–448PubMedCrossRef Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee injury and osteoarthritis outcome score (KOOS)—validation of Swedish version. Scand J Med Sci Sports 8:439–448PubMedCrossRef
40.
Zurück zum Zitat Roos EM, Roos HP, Ryd L, Lohmander LS (2000) Substantial disability 3 months after arthroscopic partial meniscectomy: a prospective study of patient relevant outcomes. J Arthrosc Rel Surg 16(6):619–626CrossRef Roos EM, Roos HP, Ryd L, Lohmander LS (2000) Substantial disability 3 months after arthroscopic partial meniscectomy: a prospective study of patient relevant outcomes. J Arthrosc Rel Surg 16(6):619–626CrossRef
41.
Zurück zum Zitat Roos E (2002) Fysisk aktivitet kan påverka tidig artros. Läkartidningen 45(99):4484–4489 Roos E (2002) Fysisk aktivitet kan påverka tidig artros. Läkartidningen 45(99):4484–4489
42.
Zurück zum Zitat Roos E, Lohmander S (2003) The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:1–8CrossRef Roos E, Lohmander S (2003) The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:1–8CrossRef
43.
Zurück zum Zitat Roos PH, Laurén M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy. Arthritis Rheum 41:687–693PubMedCrossRef Roos PH, Laurén M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy. Arthritis Rheum 41:687–693PubMedCrossRef
44.
Zurück zum Zitat St-Pierre DM, Laforest S, Paradis S, Leroux M, Charron J, Racette Dalzell MA (1992) Isokinetic rehabilitation after arthroscopic meniscectomy. Eur J Appl Physiol 64(5):437–443CrossRef St-Pierre DM, Laforest S, Paradis S, Leroux M, Charron J, Racette Dalzell MA (1992) Isokinetic rehabilitation after arthroscopic meniscectomy. Eur J Appl Physiol 64(5):437–443CrossRef
45.
Zurück zum Zitat St-Pierre D (1995) Rehabilitation following arthroscopic meniscectomy. Sports Med 20(5):338–347PubMed St-Pierre D (1995) Rehabilitation following arthroscopic meniscectomy. Sports Med 20(5):338–347PubMed
46.
Zurück zum Zitat Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49PubMed Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49PubMed
47.
Zurück zum Zitat Vervest AM, Maurer CA, Schambergen TG, de Bie RA, Bulstra SK (1999) Effectiveness of physiotherapy after meniscectomy. Knee Surg Sports Traumatol Arthrosc 7(6):360–364PubMedCrossRef Vervest AM, Maurer CA, Schambergen TG, de Bie RA, Bulstra SK (1999) Effectiveness of physiotherapy after meniscectomy. Knee Surg Sports Traumatol Arthrosc 7(6):360–364PubMedCrossRef
48.
Zurück zum Zitat Weitzel PP, Richmond JC (2002) Critical evaluation of different scoring systems. Sports Med Arthrosc Review 10:183–190CrossRef Weitzel PP, Richmond JC (2002) Critical evaluation of different scoring systems. Sports Med Arthrosc Review 10:183–190CrossRef
49.
Zurück zum Zitat Who/Nut/Ncd (1998) Preventing and managing the global epidemic. Report of world health organization’s consultation on obesity, 3–5 June 1997, Geneva, World Health Organization Who/Nut/Ncd (1998) Preventing and managing the global epidemic. Report of world health organization’s consultation on obesity, 3–5 June 1997, Geneva, World Health Organization
Metadaten
Titel
Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial
verfasst von
Sylvia Herrlin
Maria Hållander
Peter Wange
Lars Weidenhielm
Suzanne Werner
Publikationsdatum
01.04.2007
Verlag
Springer-Verlag
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 4/2007
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-006-0243-2

Weitere Artikel der Ausgabe 4/2007

Knee Surgery, Sports Traumatology, Arthroscopy 4/2007 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.