Kise exercise vs APM

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, et al. British journal of sports medicine 2016 · PMID 30142084 · doi:10.1136/bjsports-2016-i3740rep

Question

In middle-aged patients with a degenerative meniscal tear, is supervised exercise therapy as effective as arthroscopic partial meniscectomy?

Design

Randomised controlled superiority trial in Norway with 2-year follow-up.

Patients

140 adults aged 35-60 with a degenerative meniscal tear on MRI, most without definite radiographic osteoarthritis.

Intervention

12-week supervised exercise therapy

Comparison

Arthroscopic partial meniscectomy

Primary outcome

Change in KOOS4 at 2 years

Key result

There was no clinically relevant or significant difference in KOOS4 at 2 years, and the exercise group had better thigh muscle strength in the short term.

Limitations

Unblinded with some crossover from exercise to surgery; mostly excluded patients with locking.

Impact on practice

Adds to the evidence that supervised exercise should be offered first for degenerative meniscal tears instead of arthroscopic meniscectomy.