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Exercise Instead of Meniscus Repair Surgery?

A new study followed adults with meniscus tears (in the knee), who were randomly assigned to either exercise only or meniscus repair surgery (arthroscopic partial meniscectomy) only. They found that after 2 years there was no difference between those  who just received exercise therapy compared to those who just received meniscus repair surgery. About 19% of the exercise only group decided to get surgery at some point, but the rest stayed in the exercise only group.

The study in BMJ says that the exercise therapy program consisted of progressive neuromuscular and strength exercises over 12 weeks, which were performed between two and a maximum of three sessions each week (24-36 sessions). Once again, a study shows that surgery for a condition may not be necessary. From Science Daily:

Most surgical meniscus repairs are unnecessary

Three out of four people could avoid knee surgery with a new form of exercise therapy, with significant cost savings for society. Injury to the menisci, the cartilaginous discs within the knee joint, can be painful when running, and can cause the knee to give way or 'lock'. Such injuries are troublesome and sometimes painful, and can prevent you from exercising or attending work. A new study shows that exercise therapy is just as effective for treating meniscus injuries as surgery. .

A total of 140 patients with meniscus injuries in Norway and Denmark took part in the study. They drew lots for treatment with either exercise or surgery. Nina Jullum Kise says, "Two years later, both groups of patients had fewer symptoms and improved functioning. There was no difference between the two groups." However, those who had exercised had developed greater muscular strength. This is consistent with previous research, which showed that surgery yielded no additional benefits for patients who had had exercise therapy.... Jullum Kise believes that as many as three in four could be spared surgery with the right exercise therapy programme. 

In the study, the patients attended training sessions with a physiotherapist 2-3 times a week for 12 weeks. "The exercise therapy programme involves a warm up and various types of strength training. It is built up in stages that become more challenging as the patient improves and becomes stronger," explains Dr Jullum Kise. Each patient receives a personalized training programme, and learns to do the exercises under the supervision of a physiotherapist.

Menisci are crescent-shaped discs of cartilage on both sides of the knee joint. The meniscus is a shock absorber that distributes weight across the joint and at the same time stabilizes the joint when you walk or run. "We hope that the stronger muscles of the exercise therapy group may counteract osteoarthritis, a type of arthritis that often occurs in patients who have undergone surgery for a meniscus injury," says Dr Jullum Kise.

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