Medical exercise therapy alone versus arthroscopic partial meniscectomy followed by medical exercise therapy for degenerative meniscal tear: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective: To explore if medical exercise therapy (MET) alone is comparable to arthroscopic partial meniscectomy (APM) followed by MET for knee pain, activity level, and physical function in middle-aged patients with degenerative meniscal tear (DMT) by a systematic review and meta-analysis of randomized controlled trials (RCTs).

Method: A systematic search of electronic databases (PubMed, the Cochrane Library, Embase, and Web of Science) was conducted to retrieve RCTs comparing MET+APM with MET alone for DMT. Risk of bias of the studies was evaluated. Outcomes assessed were pain relief, physical function, and activity level.

Results: A total of 6 RCTs containing 879 patients were included. After pooling the data of 5 researches, we found small significant differences support the APM + MET group for pain control assessed by Knee injury and Osteoarthritis Outcome Score (KOOS) at 2 to 3 months (p = 0.004) and at 6 months (p = 0.04). And there were statistically improvements in APM + MET at 6 months compared with MET alone when changing measurement to visual analog scale (VAS) (p = 0.0003). Our analysis also found small significant differences favor the APM followed by MET group for physical function both at 2 to 3 months (p = 0.01, KOOS and Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC; and P = 0.40, Lysholm Knee Scoring Scale) and at 6 months (p = 0.01, KOOS and WOMAC).

Conclusion: We found favorable results of APM + MET up to 6 months for pain control and physical function. However, there were no differences at longer follow-up. The clinical applicability of APM + MET compared with MET should be interpreted carefully, and the potential of MET to treat DMT should be valued.

Keywords: Arthroscopic partial meniscectomy; Degenerative meniscal tear; Medical physical therapy; Meta-analysis.

Fig. 1

PRISMA flow diagram for the study selection process

Fig. 2

Risk of bias assessment

Fig. 3

Forest plots showing the pain score measured by VAS and NRS at 2 to 3, 6, 12, and 24 months. a Comparison VAS and NRS during activity—2–3 months. b Comparison VAS and NRS during activity—6 months. c Comparison VAS and NRS during activity—12 months. d Comparison VAS and NRS during activity—24 months. e Comparison VAS and NRS during rest—12 months

Fig. 4

Forest plots showing the pain score measured by KOOS pain dimension at 2 to 3, 6, and 12 months. a Comparison KOOS pain dimension—2–3 months. b Comparison KOOS pain dimension—6 months. c Comparison KOOS pain dimension—12 months

Fig. 5

Forest plots showing the physical function measured by WOMAC, KOSS and LKSS at 2 to 3, 6, and 12 months. a Comparison WOMAC physical function and KOOS ADL 2–3 months. b Comparison WOMAC physical function and KOOS-ADL 6 months. c Comparison WOMAC physical function and KOOS ADL 12 months. d Comparison LKSS 2–3 months. e Comparison LKSS 6 months. f Comparison LKSS 12 months. g Comparison LKSS-24 months. h Comparison physical function(WOMAC, KOOS, LKSS) 6 months. i Comparison physical function (WOMAC, LKSS) 6 months. j Comparison physical function (WOMAC, KOOS, LKSS) 12 months. k Comparison physical function (WOMAC, LKSS) 12 months

Fig. 6

Forest plots showing the activity level at 2 to 3 months, 12 months, and 24 months. a Comparison activity level 2–3 months. b Comparison activity level 12 months. c Comparison activity level 24 months