Re: Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up
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Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up
Re: Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up
Interesting study on Arthroscopic surgery for knee pain by Kise NJ et al (BMJ 23rd July 2016;354:i3740). They have concluded that exercise therapy is better for thigh muscle strength than surgery.
I would like to raise the following points on this article. The study performed MRI in every pt to diagnose meniscal tears. This seems a bit impractical in the current scenario with dwindling funding for hospitals, increasing demand by population on MRI where waiting times are already very high. A good clinical assessment correlated with details pt symptoms is a good enough for the surgeon to decide which pt needs an arthroscopy and MRI in the remainder when the surgeon is unsure about the diagnosis.
Secondly in degenerate meniscal tears physiotherapy may increase muscle strength but shall never resolve the mechanical symptoms like locking of knee, clicking, intermittent swelling and effusion besides on going pain. Arthroscopic surgery primarily aims at resolving mechanical symptoms due to flap tears by smoothening the motion and removing mechanical obstruction. With exercise alone the meniscal tear continues to remain or worsen over period of time.
In my opinion exercise regime shall always remain supplementary to arthroscopic surgery in select cases where surgery is indicated and to improve function and strength post operatively. It can never replace arthroscopy as primary modality of treatment. Lastly with exercise therapy alone the torn meniscus continues to cause obstructive symptoms exposing pts to increased tendency for further falls risking themselves for fractures in hip, ankle or wrist. Any pt between age group 35 to 60 would never want to continue doing sporting activities knowing the fact that a meniscal tear is sitting inside their knee.
Avinash Joshi
(Mch, FRCS, MS - Orth)
Orthopaedic Consultant
Jersey General Hospital nashjoshi@hotmail.com
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Re: Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up
Interesting study on Arthroscopic surgery for knee pain by Kise NJ et al (BMJ 23rd July 2016;354:i3740). They have concluded that exercise therapy is better for thigh muscle strength than surgery.
I would like to raise the following points on this article. The study performed MRI in every pt to diagnose meniscal tears. This seems a bit impractical in the current scenario with dwindling funding for hospitals, increasing demand by population on MRI where waiting times are already very high. A good clinical assessment correlated with details pt symptoms is a good enough for the surgeon to decide which pt needs an arthroscopy and MRI in the remainder when the surgeon is unsure about the diagnosis.
Secondly in degenerate meniscal tears physiotherapy may increase muscle strength but shall never resolve the mechanical symptoms like locking of knee, clicking, intermittent swelling and effusion besides on going pain. Arthroscopic surgery primarily aims at resolving mechanical symptoms due to flap tears by smoothening the motion and removing mechanical obstruction. With exercise alone the meniscal tear continues to remain or worsen over period of time.
In my opinion exercise regime shall always remain supplementary to arthroscopic surgery in select cases where surgery is indicated and to improve function and strength post operatively. It can never replace arthroscopy as primary modality of treatment. Lastly with exercise therapy alone the torn meniscus continues to cause obstructive symptoms exposing pts to increased tendency for further falls risking themselves for fractures in hip, ankle or wrist. Any pt between age group 35 to 60 would never want to continue doing sporting activities knowing the fact that a meniscal tear is sitting inside their knee.
Avinash Joshi
(Mch, FRCS, MS - Orth)
Orthopaedic Consultant
Jersey General Hospital
nashjoshi@hotmail.com
Competing interests: No competing interests