Innovative treatment of clinically diagnosed meniscal tears: a randomized sham-controlled trial of the Mulligan concept 'squeeze' technique

Abstract

Objective: The purpose of this study was to assess the effects of the Mulligan Concept (MC) 'squeeze' technique compared to a sham technique in participants with a clinically diagnosed meniscal tear.

Methods: A multi-site randomized sham-controlled trial of participants (n = 23), aged 24.91 ± 12.09 years, with a clinically diagnosed meniscal tear were equally and randomly divided into two groups. Groups received a maximum of six treatments over 14 days. Patient outcomes included the numeric pain rating scale (NRS), patient-specific functional scale (PSFS), the disablement in the physically active (DPA) scale and the knee injury osteoarthritis outcome score. Data were analysed using univariate ANOVA, univariate ANCOVA, and descriptive statistics.

Results: All participants in the MC 'squeeze' group met the discharge criteria of ≤2 points on the NRS, ≥9 points on the PSFS, and ≤34 points or ≤23 on the DPA Scale for chronic or acute injuries, respectively within the treatment intervention timeframe. A significant difference was found in favor of the MC 'squeeze' technique in PSFS scores (F(1, 21) = 4.40, p = .048, partial eta squared = .17, observed power = .52) and in DPA Scale scores (F(1, 21) = 7.46, p = .013, partial eta squared = .27, observed power = .74).

Discussion: The results indicate the MC 'squeeze' technique had positive effects on patient function and health-related quality of life over a period of 14 days and was clinically and statistically superior to the sham treatment. Further investigation of the MC 'squeeze' technique is warranted.

Keywords: Meniscal tears; knee pain; manual therapy; rehabilitation.

Figure 1.

Starting hand placement showing the overlap thumb grip. (A) Clinician hand placement in NWB (supine) for the MC ‘squeeze’ technique treatment in full knee extension. Clinician alleviates pressure on joint line. (B) Clinician hand placement in NWB (supine) for the MC ‘squeeze’ technique treatment in full knee flexion. Pain-free over-pressure is provided by the participant (C).

Figure 2.

Clinician hand placement in PWB (lunge) starting. (A) and ending position. (B) for the MC ‘squeeze’ technique.

Figure 3.

Clinician hand placement in FWB (squat) starting. (A) and ending position. (B) for the MC ‘squeeze’ technique.

Figure 4.

Flow chart of methods and post-study treatment options provided to each participant if assigned treatment was unsuccessful.