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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2014

01-01-2014 | Knee

Is postoperative exercise therapy necessary in patients with degenerative meniscus? A randomized controlled trial with one year follow-up

Authors: Håvard Østerås, Berit Østerås, Tom Arild Torstensen

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2014

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Abstract

Purpose

There is no consensus on a postoperative rehabilitation regimen for patients who have undergone surgery for medial meniscus damage. The aim of this investigation was to evaluate two rehabilitation approaches after arthroscopic surgery in patients with degenerative meniscus: supervised medical exercise therapy versus no treatment.

Methods

A prospective randomized controlled clinical trial. Over 4 months, 70 participants were randomly assigned into either a medical exercise therapy group (n = 36) or a control group (n = 34). Pain was a composite score of a visual analogue scale (VAS), and function was measured with a functional assessment questionnaire (KOOS), while anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Function was also measured with tests of quadriceps femoris strength and a one-leg jump test.

Results

Prognostic variables were similar between the groups at baseline, with five (7 %) patients dropping out during the treatment period and another six (8 %) before the one-year follow-up. After 3 months, the medical exercise therapy group achieved significantly better outcome effects than the control group for pain and function. The results after the 12-month follow-up indicated the same results as at posttest, whereas Hospital Anxiety and Depression Scale, fiveRM and the one-leg hop test also demonstrated a significant difference between the groups from pre- to posttest to follow-up.

Conclusion

In patients with surgery for degenerative meniscus damage, postoperative medical exercise therapy is an efficient treatment alternative compared to no treatment.

Level of evidence

I.
Literature
1.
go back to reference Akkaya N, Ardin F, Ozgen M, Akkaya S, Sahin F, Kilic A (2012) Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy; a randomized controlled trial. Clin Rehabil 26(3):224–236PubMedCrossRef Akkaya N, Ardin F, Ozgen M, Akkaya S, Sahin F, Kilic A (2012) Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy; a randomized controlled trial. Clin Rehabil 26(3):224–236PubMedCrossRef
2.
go back to reference Bjelland I, Dahl AA, Haug TT et al (2002) The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res 52(2):69–77PubMedCrossRef Bjelland I, Dahl AA, Haug TT et al (2002) The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res 52(2):69–77PubMedCrossRef
3.
go back to reference Bremander AB, Dahl LL, Roos EM (2007) Validity and reliability of functional performance tests in meniscectomized patients with or without knee osteoarthritis. Scand J Med Sci Sports 17(2):120–127PubMed Bremander AB, Dahl LL, Roos EM (2007) Validity and reliability of functional performance tests in meniscectomized patients with or without knee osteoarthritis. Scand J Med Sci Sports 17(2):120–127PubMed
4.
go back to reference Burks RT, Metcalf MH, Metcalf RW (1997) Fifteen-year follow-up of arthroscopic partial meniscectomy. Arthroscopy 13:673–679PubMedCrossRef Burks RT, Metcalf MH, Metcalf RW (1997) Fifteen-year follow-up of arthroscopic partial meniscectomy. Arthroscopy 13:673–679PubMedCrossRef
5.
go back to reference Börjesson M, Robertson E, Weidenhielm L, Mattsson E, Olsson E (1996) Physiotherapy in knee osteoarthrosis: effect on pain and walking. Physiother Res Int 1:89–97PubMedCrossRef Börjesson M, Robertson E, Weidenhielm L, Mattsson E, Olsson E (1996) Physiotherapy in knee osteoarthrosis: effect on pain and walking. Physiother Res Int 1:89–97PubMedCrossRef
6.
go back to reference Conroy DE, Hayes KW (1998) The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome. J Orthop Sports Phys Ther 28(1):3–14PubMedCrossRef Conroy DE, Hayes KW (1998) The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome. J Orthop Sports Phys Ther 28(1):3–14PubMedCrossRef
7.
go back to reference Drouin JM, Valovich-mcLeod TC, Shultz SJ, Gansneder BM, Perrin DH (2004) Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol 91(1):22–29PubMedCrossRef Drouin JM, Valovich-mcLeod TC, Shultz SJ, Gansneder BM, Perrin DH (2004) Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol 91(1):22–29PubMedCrossRef
8.
go back to reference Dye SF (2001) Therapeutic implications of a tissue homeostasis approach to patellofemoralt pain. Sports Med Arthrosc Rev 9:306–311CrossRef Dye SF (2001) Therapeutic implications of a tissue homeostasis approach to patellofemoralt pain. Sports Med Arthrosc Rev 9:306–311CrossRef
9.
go back to reference Englund M, Roos EM, Lohmander LS (2003) Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year follow-up of meniscectomy with matched controls. Arthritis Rheum 48(8):2178–2187PubMedCrossRef Englund M, Roos EM, Lohmander LS (2003) Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year follow-up of meniscectomy with matched controls. Arthritis Rheum 48(8):2178–2187PubMedCrossRef
10.
go back to reference Goodwin PC, Morrisey MC (2003) Physical Therapy After Arthroscopic Partial Meniscectomy: Is It Effective?. Exerc Sport Sci Rew:85–90 Goodwin PC, Morrisey MC (2003) Physical Therapy After Arthroscopic Partial Meniscectomy: Is It Effective?. Exerc Sport Sci Rew:85–90
11.
go back to reference Herrlin S, Hållander M, Wange P, Weidenhielm L, Werner S (2007) Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 15(4):393–401PubMedCrossRef Herrlin S, Hållander M, Wange P, Weidenhielm L, Werner S (2007) Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 15(4):393–401PubMedCrossRef
12.
go back to reference Holm I, Hammer S, Larsen S, Nordsletten L, Steen H (1995) Can a regular leg extension bench be used in testing deficits of the quadriceps muscle during rehabilitation? Scand J Med Sci Sports 5(1):29–35PubMedCrossRef Holm I, Hammer S, Larsen S, Nordsletten L, Steen H (1995) Can a regular leg extension bench be used in testing deficits of the quadriceps muscle during rehabilitation? Scand J Med Sci Sports 5(1):29–35PubMedCrossRef
14.
go back to reference Kjær P (2003) Role of extracellular matrix in adaptation of tendon and skeletal muscle to mechanical loading. Physiol Rev 83:649–698 Kjær P (2003) Role of extracellular matrix in adaptation of tendon and skeletal muscle to mechanical loading. Physiol Rev 83:649–698
15.
go back to reference Matthews P, St-Pierre DM (1996) Recovery of muscle strength following arthroscopic meniscectomy. J Orthop Sports Phys Ther 23(1):18–26PubMedCrossRef Matthews P, St-Pierre DM (1996) Recovery of muscle strength following arthroscopic meniscectomy. J Orthop Sports Phys Ther 23(1):18–26PubMedCrossRef
16.
go back to reference Moffet H, Richards CL, Malouin F, Bravo G, Paradis G (1994) Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: results of a randomized controlled study. Arch Phys Med Rehabil 75(4):415–426PubMedCrossRef Moffet H, Richards CL, Malouin F, Bravo G, Paradis G (1994) Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: results of a randomized controlled study. Arch Phys Med Rehabil 75(4):415–426PubMedCrossRef
17.
go back to reference Morrissey MC, Milligan P, Goodwin PC (2006) Evaluating treatment effectiveness: benchmarks for rehabilitation after partial meniscectomy knee arthroscopy. Am J Phys Med Rehabil 85:490–501PubMedCrossRef Morrissey MC, Milligan P, Goodwin PC (2006) Evaluating treatment effectiveness: benchmarks for rehabilitation after partial meniscectomy knee arthroscopy. Am J Phys Med Rehabil 85:490–501PubMedCrossRef
18.
go back to reference Pedersen BK, Saltin B, Saltin B (2006) Evidence for prescribing exercise as therapy in chronic disease. Scan J Med Sci Sports 16(Suppl1):3–63CrossRef Pedersen BK, Saltin B, Saltin B (2006) Evidence for prescribing exercise as therapy in chronic disease. Scan J Med Sci Sports 16(Suppl1):3–63CrossRef
19.
go back to reference Powers CM, Heino JG, Rao S, Rao S, Perry J (1999) The influence of pain on lower limb loading during gait. Clin Biomech (Bristol, Avon) 14:722–728CrossRef Powers CM, Heino JG, Rao S, Rao S, Perry J (1999) The influence of pain on lower limb loading during gait. Clin Biomech (Bristol, Avon) 14:722–728CrossRef
20.
go back to reference Roos PH, Laurèn M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy. Arthritis Rheum 41:687–693PubMedCrossRef Roos PH, Laurèn M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy. Arthritis Rheum 41:687–693PubMedCrossRef
21.
go back to reference Roos EM, Roos HP, Ryd L, Lohmander LS (2000) Substantial disability 3 months after arthroscopic partial meniscectomy: a prospective study of patient relevant outcomes. J Arthrosc Rel Surg 16(6):619–626CrossRef Roos EM, Roos HP, Ryd L, Lohmander LS (2000) Substantial disability 3 months after arthroscopic partial meniscectomy: a prospective study of patient relevant outcomes. J Arthrosc Rel Surg 16(6):619–626CrossRef
22.
go back to reference Roos EM, Ostenberg A, Roos H, Ekdahl C, Lohmander LS (2001) Long-term outcome of meniscectomy: symptoms, function, and performance tests in patients with or without radiographic osteoarthritis compared to matched controls. Osteoarthr Cartil 9(4):316–324PubMedCrossRef Roos EM, Ostenberg A, Roos H, Ekdahl C, Lohmander LS (2001) Long-term outcome of meniscectomy: symptoms, function, and performance tests in patients with or without radiographic osteoarthritis compared to matched controls. Osteoarthr Cartil 9(4):316–324PubMedCrossRef
23.
go back to reference Roos EM, Bremander AB, Englund M, Lohmander LS (2008) Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee osteoarthritis. Ann Rheum Dis 67(4):505–510PubMedCrossRef Roos EM, Bremander AB, Englund M, Lohmander LS (2008) Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee osteoarthritis. Ann Rheum Dis 67(4):505–510PubMedCrossRef
24.
go back to reference Spector TD, Cooper C (1993) Radiographic assessment of osteoarthritis in population studies: whither Kellgren and Lawrence? Osteoarthr Cartil 1(4):203–206PubMedCrossRef Spector TD, Cooper C (1993) Radiographic assessment of osteoarthritis in population studies: whither Kellgren and Lawrence? Osteoarthr Cartil 1(4):203–206PubMedCrossRef
25.
go back to reference Torstensen TA (1999) Medical Exercise Therapy for dysfunction of hip, knee and ankle—dysfunction of the lower extremity. Oslo: Holten Institute, (ISBN 82-92018-04-2) Torstensen TA (1999) Medical Exercise Therapy for dysfunction of hip, knee and ankle—dysfunction of the lower extremity. Oslo: Holten Institute, (ISBN 82-92018-04-2)
26.
go back to reference Vlayen JWS, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332CrossRef Vlayen JWS, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332CrossRef
27.
go back to reference Waddel G (1996) Keynote address for primary care forum. Low back pain: a twentieth century health care enigma. Spine 21:2820–2825CrossRef Waddel G (1996) Keynote address for primary care forum. Low back pain: a twentieth century health care enigma. Spine 21:2820–2825CrossRef
28.
go back to reference Østerås H, Østerås B, Torstensen TA (2012) Medical exercise therapy or arthroscopic surgery in degenerative meniscus damage patients. J Bodyw Mov Ther 16(4):456–463PubMedCrossRef Østerås H, Østerås B, Torstensen TA (2012) Medical exercise therapy or arthroscopic surgery in degenerative meniscus damage patients. J Bodyw Mov Ther 16(4):456–463PubMedCrossRef
Metadata
Title
Is postoperative exercise therapy necessary in patients with degenerative meniscus? A randomized controlled trial with one year follow-up
Authors
Håvard Østerås
Berit Østerås
Tom Arild Torstensen
Publication date
01-01-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-012-2354-2

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