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Knee Surg Sports Traumatol Arthrosc (2007) 15:393401

DOI 10.1007/s00167-006-0243-2

KNEE

Arthroscopic or conservative treatment of degenerative


medial meniscal tears: a prospective randomised trial
Sylvia Herrlin Maria Hallander Peter Wange
Lars Weidenhielm Suzanne Werner

Received: 24 August 2006 / Accepted: 9 November 2006 / Published online: 10 January 2007
 Springer-Verlag 2006

Abstract In this prospective randomised study two turned to their pre-injury activity level after 6 months.
treatments after non-traumatic medial meniscal tear In conclusion, when evaluated with outcome scores,
diagnosed with radiological examination and magnetic arthroscopic partial medial meniscectomy followed by
resonance imaging were compared; arthroscopic partial supervised exercise was not superior to supervised
meniscectomy followed by supervised exercise or exercise alone in terms of reduced knee pain, improved
supervised exercise alone. The aim was to evaluate knee knee function and improved quality of life.
function and physical activity. Ninety patients (mean
age 56 years) were evaluated using the Knee Injury and Keywords Arthroscopy  Knee Joint  Exercise 
Osteoarthritis Outcome Score, the Lysholm Knee Physiotherapy  Questionnaires
Scoring Scale, the Tegner Activity Scale and a Visual
Analogue Scale for knee pain prior to the intervention,
after 8 weeks of exercise and after 6 months. According Introduction
to the outcome scores arthroscopic partial medial
meniscectomy combined with exercise did not lead Middle-aged men and women with degenerative men-
to greater improvement than exercise alone. After iscal tears constitute a large group of patients pre-
the intervention both groups reported decreased knee senting with knee pain, swelling and loss of function
pain, improved knee function and a high satisfaction [3]. Many meniscal tears occur without a trauma in
(P < 0.0001). Forty-one per cent of the patients re- physically active individuals as well as in older people
and could be a part of early osteoarthritis [3, 14, 35, 36].
Battacharyya et al. [7] showed with magnetic reso-
S. Herrlin (&)
nance imaging (MRI) that medial or lateral meniscal
Department of Physiotherapy,
Rehabtjanst, S:t Eriksgatan 48, tear was a common finding in older patients with or
112 34 Stockholm, Sweden without symptomatic osteoarthritis and that 91% of
e-mail: sylvia.herrlin@tele2.se the individuals with knee related problems had an
abnormal meniscus defined as meniscus tear. This was
M. Hallander  P. Wange  S. Werner
Capio Artro Clinic, however also found in 76% of the individuals in the
Stockholm Sports Trauma Research Center, asymptomatic control group. If an injured meniscus
Karolinska Institutet, Valhallavagen 91, leads to poor knee function and knee instability, the
114 27 Stockholm, Sweden
risk of affecting the joint cartilage increases [1, 30].
L. Weidenhielm Partial arthroscopic meniscectomy is a common
Department of Molecular Medicine and Surgery, surgical procedure in patients with meniscal tears.
Karolinska Institutet, 171 76 Stockholm, Sweden Many patients report improvement after arthroscopy
referring especially to reduced knee pain, better knee
L. Weidenhielm
Department of Orthopaedics, Karolinska Hospital, function and improved quality of life [8, 40]. Chatain
171 76 Stockholm, Sweden et al. [12] reported that 91% of the patients 11.5 years

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394 Knee Surg Sports Traumatol Arthrosc (2007) 15:393401

after arthroscopic medial meniscectomy considered Inclusion criteria were: (a) age 4564 years; (b) knee
their knees normal or almost normal. In a retrospective pain without a trauma, daily or almost daily pain
follow-up study, 511 years after surgery, Matsusue experienced during the last 26 months; (c) knee
and Thomson [26] reported that 64% of the patients osteoarthritis grade 0 or 1 on weight-bearing knee
older than 40 years of age had returned to normal radiographs according to Ahlbacks classification [2];
activities and were satisfied with their knees. Despite (d) medial meniscal tear on MRI; (e) understanding of
reduced knee pain and improved knee function, Roos the Swedish language.
et al. [40] showed that 3 months after surgery a Exclusion criteria were: (a) traumatic meniscal in-
majority of the patients had decreased their physical jury; (b) neurological and rheumatic inflammatory
activity and 38% were not physically active compared diseases; (c) loose bodies, ligament injuries, osteo-
to 9% before surgery. chondral defects and tumours (MRI); (d) earlier knee
Exercise has been suggested to be an efficient treat- surgery, prosthetic replacements of the hip or knee and
ment for patients with knee degeneration in order to fractures to the lower extremities less than 1 year old;
improve knee function and to limit joint pain, acutely as (e) contraindication to physical training.
well as chronically [9, 10, 27, 29, 41]. There is strong The patients were referred to orthopaedic surgeons
evidence that physical training plays an important role in at the Capio Artro Clinic, Stockholm Sports Trauma
order to reduce symptoms, improve muscle strength and Research Center for suspected meniscal tears. They
physical ability and thereby quality of life in patients were then contacted by telephone and informed about
with osteoarthritis [32]. Physical exercise three times the study. After written informed consent they were
weekly during 4 months could lead to more than 35% randomly assigned to two different treatments; arthro-
improvement of knee function [23]. There are a number scopic partial meniscectomy followed by supervised
of reports showing that quadriceps weakens due to knee exercise or by supervised exercise alone. Patient char-
pain [e.g. 16]. However, it has also been reported that acteristics are presented in Table 1.
patients have regained the same quadriceps strength as Forty per cent of the patients did not want to par-
before surgery but have remained weaker than the ticipate mainly due to lack of time, reduced knee pain
contralateral leg after arthroscopic partial meniscectomy or own interest in choosing treatment method. After
followed by a period of 6 weeks of exercise [44]. entering the study six patients chose to end their par-
The goal of rehabilitation is to regain good knee ticipation due to reduced knee pain and three patients
control, range of motion (ROM), flexibility as well as wanted to be treated with arthroscopic surgery.
muscle strength and thereby improving knee function. A clinical examination was carried out by two
The exercise programme should consist of both con- experienced physiotherapists (test leaders). Data on
centric and eccentric exercises to receive muscular the patients medical history was collected with
hypertrophy as well as neuromuscular function [5].
There is a wide range of treatments after degenera- Table 1 Characteristics of the patients in the Arthroscopic
tive meniscus tears. However, there is still no consensus Exercise group (AE) and the Exercise group (E) (both groups
about the treatment of choice and to our knowledge no n = 90)
results have been reported when comparing arthro- Arthroscopic Exercise
scopic partial meniscectomy and supervised exercise. exercise group group
Therefore, the aim of the present investigation (n = 47) (n = 43)
was to compare two treatments; arthroscopic partial Gender
meniscectomy followed by supervised exercise and Men/women 28/19 27/16
supervised exercise alone, in terms of knee pain, knee Total 47 43
function, physical activity and quality of life in patients Agea
Men/women 54/54 (4.6/5.6) 55/59 (5.5/3.8)
with degenerative meniscal tears. Total 54 57
BMIa
Men/women 27/25 (3.9/3.9) 26/25 (3.3/6.5)
Materials and methods Total 26 26
Pain medication
Men/women yes 5/5 3/3
Patients Men/women no 23/12 24/13
Activity (Tegner)b
Ninety-nine middle-aged patients (of 180), mean age Total 3 (06) 3 (07)
a
56 years with no traumatic knee pain, were included in Mean (standard deviation)
b
this study between June 2003 and April 2005. Median (range)

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Knee Surg Sports Traumatol Arthrosc (2007) 15:393401 395

information about body mass index (BMI) [49], Tegner activity scale
number of days for sick leave, intake of medicine
and degree of pain, type of work as well as possible The Tegner Activity Scale has ten different activity
physical activity. levels and covers activities in daily life as well as in
The study was approved by the Ethical Committee sports. Levels 16 show recreational sports, levels se-
at the Karolinska Institutet in Stockholm. All patients ven to ten show competitive sports. Level 0 means sick
signed their informed consent. leave due to knee problems. The patients were asked
about their activity level before injury, at the start of
Questionnaires the intervention, as well as after 8 weeks and 6 months.
The main advantage of the Tegner Activity Scale is the
Before the start of the intervention and after 8 weeks possibility to evaluate changes in activity level over
all patients answered three questionnaires, Knee injury time for the same patient.
and Osteoarthritis Outcome Score (KOOS) [39], Lys-
holm Knee Scoring Scale [22] and Tegner Activity Exercise programme
Scale [46]. Prior to the study these questionnaires were
administered by the test leaders and after 8 weeks by Twice a week during a period of 8 weeks each patient
administrative staff. After 6 months the three ques- followed a standardised exercise programme with
tionnaires were sent by ordinary mail to the patients possibility for individual adaptation. The goal of the
for a third answer together with a formula with ques- exercise programme was to reduce pain, restore full
tions about intake of medicine, sick leave and degree ROM and improve knee function. It consisted of
of possible knee pain. exercises for improving muscle strength and endur-
ance, muscle flexibility as well as balance and propri-
Knee injury and osteoarthritis outcome score oception. The patients were informed to exert the
exercises with some strain but perform them almost
The KOOS consists of five patient-relevant subscales, pain free and without having any negative influence in
which are scored separately: pain (nine items), symp- the affected knee at the following day. If the patient
toms (seven items), activity in daily living (17 items), could tolerate the exercises without any problems he/
sport and recreational function (five items) and quality she performed the exercises with increasing weights
of life (four items). All items have five possible answer and higher resistance (Table 2).
options scored from zero (no problems) to four (heavy
problems). The scores are transformed to a 0100 scale, Table 2 The exercise programme for both groups performed
where 100 represent no knee-related problems. The during 8 weeks
KOOS has been shown to be a valid, reliable and Time Exercises
responsive instrument with a test-retest reliability of (week)
0.750.93 for the five individual sections and a respon-
siveness of 0.84 for pain to 1.65 for knee-related quality 08 Stationary bicycling Gradual increase,
715 min
of life [42]. To detect an average difference between 04 Calf raises on a leg press 3 10 repetitions
individuals as well as between groups, a minimal per- 58 Calf raises standing on one leg 3 10 repetitions
ceptible improvement was set to ten points [42]. 14 Leg press 3 10 repetitions
58 Lunges with 80 of knee flexion 3 10 repetitions
with or without weight in the
Lysholm knee scoring scale hands
04 Knee flexions concentrically with 3 10 repetitions
The Lysholm Knee Scoring Scale contains eight parts two legs and eccentrically with
(pain, swelling, instability, locking, limping, stair- one leg
58 Knee flexions with one leg 3 10 repetitions
climbing, support and squatting). No knee problems 08 Knee extensions concentrically with 3 10 repetitions
mean a total score of 100. More than 91 points are two legs and eccentrically with
suggested as an excellent knee function without one leg
symptoms during any activity [22]. The scale has been 58 Knee extensions with one leg 3 10 repetitions
08 Stair walking and balance on 3 min
proven to be valid, reliable and responsive for knee wobble boards
ligament injuries [48]. Marx [24] reported face and 08 Jogging, jumps, landing on a 5 min
content validation of the Lysholm Knee Scoring Scale rebounder
and a reliability of r = 0.95 and a responsiveness of 08 Stretching of knee extensors 1 min/muscle
and flexors group
r = 0.90.

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396 Knee Surg Sports Traumatol Arthrosc (2007) 15:393401

A written home programme was also carried out performed and 40 patients per group were needed to
twice a week. It consisted of one-leg standing during detect an average difference of ten points in the KOOS
1 min and a step down exercise each comprising 3 10 with 80% power. P = 0.05 was considered to be sta-
repetitions. Using a diary the patients noted both tistically significant.
performances of home and supervised exercises as well
as of other physical activities.
Results
Visual analogue scale
KOOS
The 10-point Visual Analogue Scale (VAS) was used
to measure the amount of possible knee pain during After 8 weeks of regular physical training twice a
the last week, at rest as well as during weight bearing week, both groups showed significantly higher scores
[21]. Pain rating at zero means no pain, while ten mean on all subscales as evaluated with the KOOS
maximal pain. (P < 0.001). In sport and recreation the AE group
scored 50 points higher and the E group 40 points
Arthroscopy higher than at the start of the study. In terms of
quality of life the AE group scored 32 points higher
Arthroscopy was performed on 47 patients on an out- and the E group 25 points higher than at the start of
patient basis by two experienced surgeons. One the study.
arthroscopy was performed in general anaesthesia and Significant improvements on all subscales of the
the rest in local anaesthesia (Mepvakain 5 mg/ml + KOOS from the start of the study to 8 weeks and to
adrenalin 5 mg 7 ml; Carbocain adrenalin; AstraZeneca, 6 months were found within groups, P < 0.001
Sweden AB) 20 + 20 ml extra and intraarticularly, (Table 3). There was a strong tendency that the E group
respectively. scored lower after 6 months compared to the 8 weeks
Two standard portals were used and no outflow follow-up in terms of sport and recreation (P = 0.052)
cannula was needed. A 5.5 mm, 30, arthroscope was but not in terms of quality of life (Figs. 1, 2, 3).
used with a pressure controlled irrigation system. The power to detect a ten points difference within
A standard operation protocol was used to document groups for sport and recreation was estimated to 84%
possible findings in cartilage, ligaments, synovium and and quality of life to 98%. Correlations between sport
the medial and lateral meniscus. Meniscal lesions were and recreation and quality of life were good in both
registered and changes in the articular cartilage were groups both at the start of the study r = 0.69
classified according to the Outerbridge classification [11, (P < 0.001) and 6 months later r = 0.78 (P < 0.001).
25, 31]; grade 0 = intact articular surfaces, grade There were no statistical group differences in any of
I = softening of the surfaces, grade II = partial-thick- the subscales at the follow-ups (Table 3).
ness defects less than 1.5 cm, grade III = partial-thick-
ness tears greater than 1.5 cm/fragmentation, grade Lysholm knee scoring scale
IV = exposed bone.
The total Lysholm score at the start of the study was
Statistics for the two groups in median 65 (range 2495) of
possible 100 points. Both groups scored significantly
Results of ordinal data were presented as median and higher after 8 weeks than at the start of the study
percentiles (P25 and P75), mean from interval and P < 0.001 (Table 4). Sixteen of 47 patients (34%) in
ratio data. The MannWhitney U-test was used to the AE group and 18 of 43 patients (42%) in the E
compare the KOOS and the Lysholm Knee Scoring group scored 91, which is suggested to be a normal
Scale between the Arthroscopic-Exercise (AE) and the knee function without symptoms during activity [20,
Exercise (E) groups. For comparisons over time, 22]. There were lower scores for the AE group at
ANOVA and Friedmans ANOVA by ranks, followed 6 months compared with 8 weeks follow-up, P = 0.05.
by multiple comparisons between visits were per- Within groups there were no statistical differences at
formed. The Spearman Rank Order Correlation was the follow-ups.
used to measure the association between the KOOS There was a high correlation between the total
and the Lysholm Knee Scoring Scale and the correla- scores of the Lysholm Knee Scoring Scale and the
tions between the single variables in the KOOS: sport/ KOOS subscales, at the start of the study (r = 0.74)
recreation and quality of life. A power analysis was and after 6 months (r = 0.84), P < 0.001.

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Knee Surg Sports Traumatol Arthrosc (2007) 15:393401 397

Table 3 The result of the


AE-group E-group P-values between groups
KOOS scores reported as
median and range [lower Start of the study
quartile (P25)upper quartile Pain 56 (4467) 62 (5078) 0.08
(P75)] at the start, after Symptom 64 (5075) 71 (5782) 0.16
8 weeks and 6 months after ADL 68 (5481) 79 (5487) 0.32
the intervention for the Sport/Rec 20 (540) 30 (1050) 0.09
Arthroscopic Exercise group QOL 31 (2550) 38 (2550) 0.67
(AE) (n = 47) and the After 8 weeks
Exercise group (E) (n = 43) Pain 89 (7294) 86 (7594) 0.90
Symptoms 86 (7593) 89 (7596) 0.48
ADL 93 (8597) 96 (7899) 0.53
Sport/Rec 70 (3585) 70 (5090) 0.12
QOL 63 (5075) 63 (4469) 0.59
After 6 months P-values between groups,
8 weeks and 6 months
Pain 89 (7597) 86 (7294) 0.42
Symptoms 89 (7996) 86 (7996) 0.94
P-values are given for ADL 84 (81100) 96 (7699) 0.56
comparisons between groups. Sport/Rec 70 (3090) 65 (3585) 0.80
P-values within groups QOL 69 (4488) 63 (4475) 0.61
were \ 0.001

Tegner activity scale patients (40%) had reached their pre-injury activity
level. Seventy per cent of all patients reported that
Of 90 patients, 34 patients (72%) in the AE group and they had reached level 3 or higher.
30 patients (70%) in the E group reported a decreased
physical activity level when their knee problems star- Visual analogue scale
ted. Before injury the patients scored 4 (median) on
the Tegner Activity Scale (Table 4). This means, for Pain was reported significantly lower on the outcome
instance, jogging on even ground, gymnastics with scores as well as on the VAS scale after 8 weeks of
jumps and cross-country skiing. After 8 weeks 18 of 47 regular exercise in both groups (P < 0.001). Pain rat-
patients (42%) in the AE group and 22 of 43 patients ings during physical activity using the VAS showed a
(51%) in the E group had reached their pre-injury median value of 5.5 at the start of the study for
activity level. This was the same after 6 months for the both groups. After two and 6 months they scored 1.0
AE group, but not for the E group where 17 of 43 (Table 4).

Fig. 1 KOOS scores 100


(median); subscales Pain,
Symptoms, ADL, Sport/Rec 90
and QOL reported at the start
as an outcome profile for the 80
Arthroscopic Exercise group,
AE = open circle (n = 47) 70
and the Exercise group,
E = open square (n = 43) 60

50

40

30

20
AE
10 E

0
Pain 0 Symptoms 0 ADL 0 Sport/Rec 0 QOL 0

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398 Knee Surg Sports Traumatol Arthrosc (2007) 15:393401

Fig. 2 KOOS scores 100


(median); subscales Pain,
Symptoms, ADL, Sport/Rec 90
and QOL reported after
8 weeks as an outcome profile 80
for the Arthroscopic Exercise
group, AE = open circle 70
(n = 47) and the Exercise
group, E = open square 60
(n = 43)
50

40

30

20
AE
10 E

0
Pain 2 Symptoms 2 ADL 2 Sport/Rec 2 QOL 2

Fig. 3 KOOS scores 100


(median); subscales Pain,
Symptoms, ADL, Sport/Rec 90
and QOL reported after
6 months as an outcome 80
profile for the Arthroscopic
Exercise group, AE = open 70
circle (n = 47) and the
Exercise group, E = open 60
square (n = 43)
50

40

30

20
AE
10 E

0
Pain 6 Symptoms 6 ADL 6 Sport/Rec 6 QOL 6

Table 4 The result of the Lysholm total score, Tegner Activity after the intervention for the Arthroscopic Exercise group (AE)
Scale and Vas scale reported as median and range lower quartile (n = 47) and the Exercise group (E) (n = 43)
(P25)upper quartile (P75) at the start, 8 weeks and 6 months
Lysholm total score VAS, movement VAS, rest Tegner activity level
AE-group E-group AE-group E-group AE-group E-group AE-group E-group

Pre-injury 4 (35) 4 (35)


Start of the study 61 (4970) 73 (5683) 6 (38) 5 (27) 2 (04) 1 (05) 3 (23) 3 (23)
After 8 weeks 88 (7993) 90 (7895) 1 (03) 1 (03) 0 (01) 0 (02) 3 (34) 3 (34)
After 6 months 84 (7094) 85 (7194) 1 (13) 1 (14) 0 (02) 0 (02) 3 (24) 3 (24)
P-values within groups were < 0.001

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Knee Surg Sports Traumatol Arthrosc (2007) 15:393401 399

Arthroscopy arthroscopy could contribute to a fast rehabilitation


and to high-patient satisfaction. With critical reviews of
Forty-two patients had medial meniscal tears and two clinical trials, Goodyear-Smith and Arroll [19] and
patients had tears of both their medial and lateral Goodwin and Morrissey [17] have not found enough
menisci. Three patients had no meniscal tears. All evidence for physical therapy following arthroscopy to
meniscal tears were treated with partial resection. The lead to gains in functional improvements in patients
location of the meniscal tears on pre-operative MRI below 40 years of age. They recommend a home
was in agreement with the meniscal tears that were exercise programme together with verbal instructions
found and treated during surgery except for three pa- to patients after an uncomplicated arthroscopic partial
tients where no meniscal tear was found. meniscectomy. The referred clinical trials were
Degenerative and/or other chondral lesions were however characterised by small sample sizes and short-
found in 40 cases. According to the Outerbridge clas- term follow-ups. The discrepancy of results from
sification [11, 31] there were seven patients with grade earlier studies and the present study after training
I, six with grade II, nineteen with grade III and eight sessions can rely on lack of using standardised outcome
with grade IV. Thirty patients had cartilage changes scores especially comprising subscales of quality of life.
grades IIIV of the medial joint compartment, 21 had With arthroscopic partial meniscectomy as the only
grades IIIV in the patellofemoral joint and six in the intervention Roos et al. [39] reported great improve-
lateral compartment. ment after 3 months in all subscales of the KOOS. This
Fourteen of the degenerative chondral lesions with improvement was less than in the present study where
unstable flaps were treated by debridement with a the patients also received special knee training after
motorized shaver. Ten of these debridements con- surgery. Since not enough evidence points out the va-
cerned the medial aspect of the joint. lue of exercise after arthroscopy after medial meniscal
resection (19, 17), a third group treated with arthros-
copy alone might have improved the study.
Discussion In agreement with other authors we also found a
reduction or cessation of sports after arthroscopic
The purpose of the present investigation was to com- meniscectomy especially in patients with degenerative
pare two treatments for middle-aged patients with non- knee changes [13, 35]. The patients in our study have
traumatic medial meniscal tear. Two groups of patients dropped their level of activity by 1 or more grades,
performed supervised exercise twice a week during which are in line with the mentioned studies. Fifty-nine
8 weeks, one after arthroscopic partial meniscectomy. per cent of the patients did not reach their pre-injury
After a period of 8 weeks of exercise both groups activity level after 6 months. There is a higher rate of
showed great improvements when evaluated with dif- patients nowadays not returning to sports than it was
ferent outcome questionnaires. The value of exercise 20 years ago, when supervised rehabilitation after
as a treatment option after meniscal tears has not been surgery was more common than today [38].
sufficiently studied. Resistance training has been re- Arthroscopy can be an effective short as well as
ported to be effective in rehabilitation of orthopaedic long-term treatment especially in those without artic-
injuries [15]. Aichroth [3] recommends treating de- ular cartilage damage [8, 20, 26]. Meniscal tears in the
tected meniscal tears on MRI with mobility and outer zones can be treated successfully [1]. Patients
strengthening exercises and gradually increased resis- with non-degenerative meniscal tears are more satis-
tance training. We, like other authors [4, 15], would fied with their knee function after arthroscopy than
like to point out the importance of exercise pro- those patients with degenerative meniscal tears [3, 13,
grammes tailored for each individual in order to reach 14, 28]. Since there is an increased risk of developing
the best clinical outcome. Furthermore, our clinical radiographic tibiofemoral osteoarthritis for individuals
impression of the present study suggested to start with older than 40 years of age after arthroscopic menisc-
supervised training sessions to optimise the perfor- ectomy [12, 34, 43], exercise treatment during several
mance of the exercises with core stability and control weeks could be recommended as the first choice.
of the knee and to develop the exercises according to Our results are based on the formulas KOOS and
the patients former experience. the Lysholm Knee Scoring Scale and the Tegner
The majority of scientific publications deals with Activity Scale. KOOS is validated for young and
rehabilitation after arthroscopy [18, 27, 29, 44, 45, 47]. middle-aged patients with various knee disorders like
In accordance with a few studies [29, 46] the patients in meniscal pathology [42]. The high-rank correlation
the AE group showed that supervised exercise after between KOOS and the Lysholm Knee Scoring Scale

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400 Knee Surg Sports Traumatol Arthrosc (2007) 15:393401

could mean that the formulas were equal to show respectively. Despite this fact no statistical differences
subjective evaluation of knee problems for patients between the groups at the start in KOOS regarding
with meniscal tears. The Lysholm Knee Scoring Scale, ADL and Sport/Recreation were found. Postopera-
designed for the evaluation of knee ligament injuries, tively the scores of the two groups were of the same
has been reported to be most sensitive for patients with magnitude. This difference at the start could have
meniscal tears [6]. However, the lower total Lysholm influenced the results especially in those patients
score for the AE-group after 6 months could mean that belonging to the AE group. This might give evidence
the scale might not be sensitive enough to changes over to a subjectively evaluated slightly greater improve-
time [37]. The high reliability on face and content ment by the patients in the arthroscopic exercise group
validation of the Lysholm Knee Scoring Scale, which compared to the exercise group. No statistical signifi-
was reported by Marx [24], was made on physically cant difference at the follow-ups was found between
active young people with ligament injuries ( 4 in the the groups in the subscales of KOOS but there was a
Tegner Activity Scale). The patients in the present strong tendency that the patients in the E group scored
study had a mean age of 56 years. Most patients re- lower in the subscale sport and recreation after
ported their activity level to be within the recreational 6 months compared to 8 weeks when regular super-
range ( 4). If people reduce their activity, there vised training twice a week had ended.
might be a risk that they score higher on the Lysholm Despite the power analysis with a power of at least
Knee Scoring Scale, since they are not performing knee 80%, our sample sizes might have been too small to be
demanding activities. Our results point in the opposite able to show possible differences between the groups.
direction. After 8 weeks of knee demanding exercises Since several authors report good long-term results
the median value for both groups on the total Lysholm after arthroscopy [3, 8, 12, 26], a longer follow-up time
score was close to 90 (of 100), while after 6 months might also be needed to detect possible differences
with reduced regular exercise the median value between the groups.
was somewhat lower, 85. Despite the high score on In conclusion, a combination of arthroscopic partial
the Lysholm Knee Scoring Scale as well as great meniscectomy and supervised exercise does not nec-
improvements in all subscales of the KOOS, after essarily lead to greater improvements of knee function
6 months only 41% of the patients had returned to compared to supervised exercise alone in middle-aged
their pre-injury physical activity level. This could patients with non-traumatic medial meniscal tears. In
indicate that it takes more than 6 months after either light of our findings we recommend supervised exercise
arthroscopic partial meniscectomy and/or exercise alone as the first choice of treatment.
therapy for a successful return to former physical
activities or that these patients overestimate their
regular physical activity before injury. References
The patients were included after clinical examination,
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