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Results support physical therapy or arthroscopic partial meniscectomy in degenerative knees

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BARCELONA, Spain — Arthroscopic partial meniscectomy was as effective as physical therapy in patients with degenerative knees and a confirmed meniscal tear that was non-obstructive, according to results of a multicenter study presented at the EFORT Annual Congress.

Victor A. van de Graaf

At the meeting, Victor A. van de Graaf, MD, Rudolf W. Poolman, MD, PhD, and colleagues at OLVG Ziekenhuis in Amsterdam received the EFORT Gold Orthopedics Free Paper Award, which designated their paper as the best one in the orthopedic category at the congress.

Participants in the study, which was conducted at six hospitals in the Netherlands, were consented and then randomized 1:1 to either arthroscopic partial meniscectomy (APM) or physical therapy (PT). They were also stratified by age into a group of patients aged 45 to 57 years and a group aged 58 to 70 years.

The mean improvement in the IKDC score from baseline to the 24-month follow-up was the primary outcome, results of which were more favorable for the APM group.

“In both groups, over 80% comprised of complex and horizontal meniscal tears,” van de Graaf said.

In discussing some of the analytical findings, he said both groups improved by at least 50% in knee function during follow-up.

“Another thing that stands out is that the blue group [on the graph], which represents the APM group, seems to improve slightly better than the physical therapy group,” van de Graaf said.

The study abstract listed mean differences in IKDC scores between groups at follow-ups that occurred at 3, 6, 12 and 24 months and noted all the differences favored surgery.

“The physical therapy is a valuable alternative to APM in most patients. The results of this trial warrant to further limit APM from the guidelines. Finally, I think it is important that future research should focus on and identify several patients who did not benefit from physical therapy. They were the patients who received late APM,” van de Graaf said. – by Susan M. Rapp

Reference:

van de Graaf VA, et al. Paper 1779. Presented at: EFORT Annual Congress; May 30-June 1, 2018; Barcelona, Spain.

Disclosure: van de Graaf reports the study was funded by various grants issued by agencies in the Netherlands.

Editor's Note: The article was updated on June 11.