For young people with meniscal tears, surgery and exercise are equally effective
The first study in the world comparing surgical and non-surgical treatment of meniscal tears in young people shows that exercise and patient education provide similar results as surgery.
Meniscal tears are among the most frequent knee injuries and surgery is the preferred treatment in most of the world for young people with knee injury. In the United States alone, one million operations are performed every year on knee injuries.
Now a new study shows that surgery and exercise are equally effective.
Researchers from the University of Southern Denmark (SDU) and a number of orthopaedic departments at Danish hospitals have conducted a study comparing exercise and patient education versus surgery of meniscal injuries among 121 young people.
Important new knowledge
In this study, published in NEJM Evidence, the researchers demonstrate that young people with a meniscal tear initially undergoing surgery do not achieve superior outcome compared to young people starting with exercise and education, with the option of later surgery.
- Meniscal tear is a frequent knee injury and until now it has been unknown how the effects of surgery and exercise compare in young people. Knee injuries can have major consequences both in the short and long run. It is therefore important that we now know there are several effective treatments to choose from, says Søren T. Skou, Professor at the Research Unit for Musculoskeletal Function and Physiotherapy at SDU and Head of Research in PROgrez at Næstved, Slagelse and Ringsted Hospitals.
Discovering more possible treatments
In the short term, a meniscal injury often means absence from work or study.
Studies also show that if you have had an anterior cruciate ligament or meniscal tear, you face a 50 percent risk of osteoarthritis 10-15 years later, and only half of patients can return to playing sports at the same level as before.
It is therefore important that patients receive the treatment that is best for them. As mentioned, this may involve both targeted exercise and/or surgery.
- Changing established treatments is difficult, and surgery is usually the go-to treatment for meniscal tears. We hope that our study can make patients and clinicians, both GPs and orthopaedic surgeons, realize that there are several possible treatments, says Jonas B. Thorlund, Professor and Head of Research at the Research Unit for Musculoskeletal Function and Physiotherapy and part of the Research Unit for General Practice at SDU.
Backed up by orthopaedic surgeons
Orthopaedic surgeons from Amager-Hvidovre Hospital, Aarhus University Hospital, Aalborg University Hospital, Lillebælt Hospital, Silkeborg Regional Hospital, Næstved Hospital and Odense University Hospital participated in the study.
About the study:
In the new study, 121 young adults were randomized to surgery or 12 weeks of supervised exercise and education (twice weekly), with the option of later surgery.
A quarter of patients in the exercise group also ended up undergoing surgery.
After 12 months, the researchers assessed the patients’ pain, function and quality of life, and here the results showed that the group that had undergone surgery did not improve more than the group undergoing exercise and education with the option of later surgery.
One of them is Per Hölmich, Professor and Head of the SORC-C (Sports Orthopedic Research Center-Copenhagen) Research Unit at the Orthopaedic Surgery Department, Amager-Hvidovre Hospital.
- It is an exciting and interesting finding that among young patients with a meniscal tear, some are doing well without surgery, he says.
- As with many other diseases and injuries, choosing the right treatment for the individual patient often comes down to a variety of factors. With this study, we have shown that surgery is still a significant treatment option for many of these patients, but that the decision to perform surgery or not is not always a foregone conclusion. There is basis for further studies so that over time we can offer even more individualized treatment.
More studies in the pipeline
The researchers behind the current study will work to disseminate knowledge from the study through courses, materials aimed at healthcare professionals and patients, and introduce it into future clinical guidelines to ensure that it benefits as many people as possible.
- We are continuing our research in this area and are currently investigating whether MRI scans of patients two years after a meniscal injury will allow us to see signs of osteoarthritis and whether there is a difference between the scans of those who have had surgery and those who have completed the exercise programme. Our goal is to be able to show whether one or the other treatment is better at preventing osteoarthritis later in life, says Søren T. Skou.
The study was published in NEJM Evidence on 25 January 2022.
The study was funded by the Independent Research Fund Denmark, IMK Almene Fond, the Lundbeck Foundation, Spar Nord Fonden, Research Council at Næstved-Slagelse-Ringsted Hospitals, Region Zealand (Exercise First), the Danish Rheumatism Association and the Association of Danish Physiotherapists.
Facts about meniscal damage:
The menisci are two cartilage discs located between the femur and tibia bones of the knee joint. Their main functions are to distribute the weight, thereby loading the cartilage less when walking and running, and to stabilise the knee joint along with the ligaments.
Tears may occur across or along the meniscus. A small piece of the meniscus can then become trapped between the joint surfaces when the knee is moving. In some cases, a larger part of the meniscus may become trapped so that the knee cannot move normally (locking).
Meet the researcher
Søren T. Skou is Professor at the Research Unit for Musculoskeletal Function and Physiotherapy at SDU and Head of Research in PROgrez at Næstved, Slagelse and Ringsted Hospitals.
Meet the researcher
Jonas B. Thorlund is professor and Head of Research at the Research Unit for Musculoskeletal Function and Physiotherapy and part of the Research Unit for General Practice at SDU.