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Exercise therapy may be as effective as arthroscopic partial menisectomy in treating degenerative meniscal tears [commentary]
G Model
JPHYS 281 1 Journal of Physiotherapy xxx (2016) xxx–xxx
Journal of
PHYSIOTHERAPY journal homepage: www.elsevier.com/locate/jphys 2 1 3 4
Appraisal
Critically Appraised Papers
Exercise therapy may be as effective as arthroscopic partial menisectomy in treating degenerative meniscal tears [commentary]
5
Commentary
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Patients referred to physiotherapy with a degenerative meniscal tear often ask for an opinion as to whether they should consider surgery or pursue conservative treatment. Kise et al found no clinically relevant differences between surgery and conservative groups after 2 years, which strengthens the evidence on this topic. These results provide support for exercise therapy supervised by physiotherapists as an intervention for patients referred with degenerative meniscal tears. If these results are implemented into practice, they may result in fewer arthroscopic surgeries being completed for this condition, with subsequent health economic benefits. There is a lack of consensus regarding what kind of conservative regimen is associated with better long-term clinical outcomes. In the study by Kise et al, participants performed 2 to3 exercise sessions weekly over 12 weeks; however, only 61% completed more than 17 sessions. The compliance within every single exercise sessions was not reported. Further trials should investigate the potential dose-response relationship in this patient group, along with activities of daily living. The duration of adherence to a physiotherapy exercise regimen without satisfactory improvement should also be investigated.
The study is an important step forward in the treatment of this large group of patients. Primary doctors, orthopaedic surgeons and physiotherapists should be working towards better-coordinated treatment plans for these patients. There is a low level of association between magnetic resonance imaging findings and longstanding atraumatic knee pain.1 The emphasis on radiologic findings in magnetic resonance imaging should be investigated, in the light of increasing evidence for random radiologic findings without clinical significance.2 Future studies could also focus on defining prognostic factors, including self-efficacy and potential for implementation of the rehabilitation guidelines.
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Provenance: Invited. Not peer reviewed.
39 40 Ha˚vard Østera˚s Q141 Department of Health Sciences, Norwegian University of Science and 42 Technology, Trondheim, Norway 43
References
44 45
1. Link TM, et al. Radiology. 2003;226:373–381. 2. Phan CM, et al. Eur Radiol. 2006;6:608–618.
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http://dx.doi.org/10.1016/j.jphys.2016.10.002 1836-9553/ß 2016 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Østera˚s H. Exercise therapy may be as effective as arthroscopic partial menisectomy in treating degenerative meniscal tears [commentary]. J Physiother. (2016), http://dx.doi.org/10.1016/j.jphys.2016.10.002
JPHYS 281 1 Journal of Physiotherapy xxx (2016) xxx–xxx
Journal of
PHYSIOTHERAPY journal homepage: www.elsevier.com/locate/jphys 2 1 3 4
Appraisal
Critically Appraised Papers
Exercise therapy may be as effective as arthroscopic partial menisectomy in treating degenerative meniscal tears [commentary]
5
Commentary
6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
Patients referred to physiotherapy with a degenerative meniscal tear often ask for an opinion as to whether they should consider surgery or pursue conservative treatment. Kise et al found no clinically relevant differences between surgery and conservative groups after 2 years, which strengthens the evidence on this topic. These results provide support for exercise therapy supervised by physiotherapists as an intervention for patients referred with degenerative meniscal tears. If these results are implemented into practice, they may result in fewer arthroscopic surgeries being completed for this condition, with subsequent health economic benefits. There is a lack of consensus regarding what kind of conservative regimen is associated with better long-term clinical outcomes. In the study by Kise et al, participants performed 2 to3 exercise sessions weekly over 12 weeks; however, only 61% completed more than 17 sessions. The compliance within every single exercise sessions was not reported. Further trials should investigate the potential dose-response relationship in this patient group, along with activities of daily living. The duration of adherence to a physiotherapy exercise regimen without satisfactory improvement should also be investigated.
The study is an important step forward in the treatment of this large group of patients. Primary doctors, orthopaedic surgeons and physiotherapists should be working towards better-coordinated treatment plans for these patients. There is a low level of association between magnetic resonance imaging findings and longstanding atraumatic knee pain.1 The emphasis on radiologic findings in magnetic resonance imaging should be investigated, in the light of increasing evidence for random radiologic findings without clinical significance.2 Future studies could also focus on defining prognostic factors, including self-efficacy and potential for implementation of the rehabilitation guidelines.
28 29 30 31 32 33 34 35 36 37 38
Provenance: Invited. Not peer reviewed.
39 40 Ha˚vard Østera˚s Q141 Department of Health Sciences, Norwegian University of Science and 42 Technology, Trondheim, Norway 43
References
44 45
1. Link TM, et al. Radiology. 2003;226:373–381. 2. Phan CM, et al. Eur Radiol. 2006;6:608–618.
46 47
27
http://dx.doi.org/10.1016/j.jphys.2016.10.002 1836-9553/ß 2016 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Østera˚s H. Exercise therapy may be as effective as arthroscopic partial menisectomy in treating degenerative meniscal tears [commentary]. J Physiother. (2016), http://dx.doi.org/10.1016/j.jphys.2016.10.002