Surgery versus Physical Therapy for Meniscal Tear and Osteoarthritis

Holzer, Lukas A.; Leithner, Andreas; Holzer, Gerold

doi:10.1056/nejmc1307177

Cited by 53 publications

(9 citation statements)

References 26 publications

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“…Several randomized controlled trials designed to evaluate the effect of arthroscopy on middle-aged patients with knee pain with or without OA have, however, not shown any beneficial effect of surgery over placebo surgery or physiotherapy. (Moseley et al 2002, Herrlin et al 2007, Kirkley et al 2008, Katz and Losina 2013, Sihvonen et al 2013, Yim et al 2013). Only 1 study has indicated a slightly better effect of knee arthroscopy with partial meniscectomy than of physiotherapy alone, but this study did not include any sham operation (so a stronger placebo effect in surgery patients cannot be excluded) (Gauffin et al 2014).…”

Section: Discussionmentioning

confidence: 99%

Knee arthroscopies: who gets them, what does the radiologist report, and what does the surgeon find?

et al. 2015

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Background and purposeSeveral randomized controlled trials have not shown any added benefit of arthroscopy over placebo surgery or physiotherapy in middle-aged patients with knee symptoms without trauma. We studied the characteristics of the knee arthroscopies performed in southern Sweden.Patients and methodsFrom the orthopedic surgical records from 2007–2009 in the Skåne region of Sweden (with a population of 1.2 million), we retrieved ICD-10 diagnostic codes and selected all 4,096 arthroscopies that were diagnosed peroperatively with code M23.2 (derangement of meniscus due to old tear or injury) or code M17 (knee osteoarthritis). We extracted information on cartilage and meniscus status at arthroscopy, and we also randomly sampled 502 of these patients from the regional archive of radiology and analyzed the preoperative prevalence of radiographic or magnetic resonance imaging (MRI)-defined osteoarthritis.Results2,165 (53%) of the 4,096 arthroscopies had the diagnostic code M23.2 or M17. In this subgroup, 1,375 cases (64%) had typical findings consistent with degenerative meniscal tear (i.e. that correspond to a degenerative meniscal tear in at least a third of all arthroscopies). Of the randomly sampled patients, the preoperative prevalence of radiological knee osteoarthritis was 46%.InterpretationThere is a discrepancy between evidence-based medicine treatment guidelines and clinical practice regarding the amount of knee arthroscopies performed in patients with symptoms of degenerative knee disease.

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Section: Discussionmentioning

confidence: 99%

Knee arthroscopies: who gets them, what does the radiologist report, and what does the surgeon find?

et al. 2015

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“…A multi-centred RCT by Katz et al published in the New England Journal of Medicine also compared APM with physical therapy [ 19 ]. Subjects were symptomatic patients aged 45 years and over with a meniscus tear and evidence of OA (0-3 by Kellgren-Lawrence criteria).…”

Section: Introductionmentioning

confidence: 99%

The Role of Arthroscopic Partial Meniscectomy in the Management of Degenerative Meniscus Tears: A Review of the Recent Literature

Azam¹,

Shenoy²

2016

TOORTHJ

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Background:The use of arthroscopic partial meniscectomy for middle aged to older adults with knee pain is one of the most common surgical procedures with approximately 150,000 knee arthroscopies being carried out in the United Kingdom each year, and about five times that number in the United States. Despite this, the procedure remains controversial. The aim of this paper is to provide a comprehensive review of the role of arthroscopic meniscectomy in patients with degenerative meniscus tears and suggest recommendations for clinical practice.Methods:A thorough literature search was performed using available databases, including Pubmed, Medline, EMBASE and the Cochrane Library to cover important randomised control trials surrounding the use of arthroscopic partial meniscectomy.Results:The majority of randomised control trials suggest that arthroscopic partial meniscectomy is not superior to conservative measures such as exercise programmes. Furthermore, one randomised control trial found that arthroscopic partial meniscectomy was not even superior to sham surgery.Conclusion:There is significant overtreatment of knee pain with arthroscopic partial meniscectomy when alternative, less invasive and less expensive treatment options are equally effective. First-line treatment of degenerative meniscus tears should be non-operative therapy focused on analgesia and physical therapy to provide pain relief as well as improve mechanical function of the knee joint. Arthroscopic partial meniscectomy should be considered as a last resort when extensive exercise programmes and physiotherapy have been tried and failed.

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“…According to the evidence-based guideline of American Academy of Orthopaedic Surgeons (AAOS), treatment for OA including glucosamine, chondroitin, acupuncture, physical agents, and lateral wedge insoles were not recommended while the only pharmacologic treatment recommended for OA was nonsteroidal anti-inflammatory drugs (NSAIDs; oral or topical) or tramadol for patients with symptomatic OA of the knee, merely providing symptomatic relief from pain and failing to prevent cartilage damage and subsequent destruction of other joint tissues [ 1 ]. In recent years, New England Journal of Medicine published a series of results of controlled clinical trials demonstrating little effect of arthroscopic surgery for the treatment of OA [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Human Adipose-Derived Mesenchymal Progenitor Cells Engraft into Rabbit Articular Cartilage

Wang

Feng

et al. 2015

IJMS

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Mesenchymal stem cells (MSCs) are known to have the potential for articular cartilage regeneration, and are suggested for the treatment of osteoarthritis (OA). Here, we investigated whether intra-articular injection of xenogeneic human adipose-derived mesenchymal progenitor cells (haMPCs) promoted articular cartilage repair in rabbit OA model and engrafted into rabbit articular cartilage. The haMPCs were cultured in vitro, and phenotypes and differentiation characteristics of cells were evaluated. OA was induced surgically by anterior cruciate ligament transection (ACLT) and medical meniscectomy of knee joints. At six weeks following surgery, hyaluronic acid (HA) or haMPCs was injected into the knee joints, the contralateral knee served as normal control. All animals were sacrificed at the 16th week post-surgery. Assessments were carried out by macroscopic examination, hematoxylin/eosin (HE) and Safranin-O/Fast green stainings and immunohistochemistry. The data showed that haMPC treatment promoted cartilage repair. Signals of human mitochondrial can be directly detected in haMPC treated cartilage. The haMPCs expressed human leukocyte antigen I (HLA-I) but not HLA-II-DR in vivo. These results suggest that intra-articular injection of haMPCs promotes regeneration of articular cartilage in rabbit OA model, and support the notion that MPCs are transplantable between HLA-incompatible individuals.

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Surgery versus Physical Therapy for Meniscal Tear and Osteoarthritis

Abstract: Matava, Matthew J.; Smith, Matthew V.; Wright, Rick W.; and et al, ,"Surgery versus physical therapy for a meniscal tear and osteoarthritis

Cited by 53 publications

References 26 publications

Knee arthroscopies: who gets them, what does the radiologist report, and what does the surgeon find?

Knee arthroscopies: who gets them, what does the radiologist report, and what does the surgeon find?

The Role of Arthroscopic Partial Meniscectomy in the Management of Degenerative Meniscus Tears: A Review of the Recent Literature

Human Adipose-Derived Mesenchymal Progenitor Cells Engraft into Rabbit Articular Cartilage

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