Knee Locking or Catching Don't Benefit from Arthroscopic Partial Meniscectomy.

[Argirios Argiriou]

February 16, 2016

Patients with Knee Locking or Catching Don't Benefit from Arthroscopic Partial Meniscectomy.

Jonathan S. Coblyn, MD reviewing Sihvonen R et al. Ann Intern Med 2016 Feb 9. Katz JN and Jones MH. Ann Intern Med 2016 Feb 9.

This study adds to the growing literature favoring initial treatment with physical therapy.

The classical treatment for nontraumatic knee pain associated with mechanical symptoms (the sensation of the knee catching or locking) has been arthroscopic partial meniscectomy. Because true “locked knee” is caused by a bucket-handle meniscus tear, we have assumed that mechanical symptoms also are related to meniscal tears. However, the efficacy of arthroscopic surgery in alleviating mechanical symptoms in patients with degenerative meniscal tears has not been evaluated in a randomized trial.

In a previously published, randomized trial from Finland, meniscectomy did not improve pain or function (compared with sham surgery) in 146 patients with magnetic resonance imaging–proven meniscal tears and >3 months of knee pain that was unresponsive to conservative therapy (NEJM JW Gen Med Feb 15 2014 and N Engl J Med 2013; 369:2515). In this post hoc analysis of the same patients, researchers assessed the presence or absence of mechanical symptoms after meniscectomy or sham surgery. Mechanical symptoms were reported by 49% of the meniscectomy group and by 43% of the sham group at some point during 12 months of follow-up. In the subgroup of 69 patients with preoperative mechanical symptoms, 72% in the meniscectomy group and 59% in the sham group reported mechanical symptoms at least once during follow-up, but this difference was not significant.

COMMENT

In this study, partial meniscectomy was not more effective than sham surgery in relieving mechanical symptoms. The etiology of such symptoms is unclear and might not be related to mechanical meniscal involvement. Previous evidence suggested that physical therapy and arthroscopic partial meniscectomy are equivalent and that initial physical therapy for knee pain for degenerative meniscal tears in middle-aged and older patients should be favored (although 20% of physical therapy patients do cross over to surgery). The same can now be said for patients with mechanical symptoms.
( βέβαια το θέμα είναι και για τι είδους φυσιοθεραπείες μιλάμε. Υπάρχουν Φυσιοθεραπευτές και Φυσιοθεραπευτές...)
EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Jonathan S. Coblyn, MD at time of publication
Consultant / Advisory boardCVS Health (member, Pharmacy and Therapeutics Committee)

CITATION(S):

Sihvonen R et al. Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear: A secondary analysis of a randomized trial. Ann Intern Med 2016 Feb 9; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)
Katz JN and Jones MH.Treatment of meniscal tear: The more we learn, the less we know. Ann Intern Med 2016 Feb 9; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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