In middle aged patients with degenerative meniscal tear, there was no difference in treatment effect between exercise therapy and arthroscopic partial meniscectomy at 2 years follow-up, according to a recent study. The study evaluated 140 adults (mean age 49.5 years) with degenerative medial meniscal tear and 12-week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. Researchers found:

• There was no clinically relevant difference between the 2 groups in change in knee injury and osteoarthritis outcome score (KOOS₄) at 2 years.

• At 3 months, muscle strength had improved in the exercise group.

• There were no serious adverse events in either group during the 2-year follow-up.

• No additional benefit was observed for 19% of participants allocated to exercise therapy who crossed over to surgery during the 2-year follow-up.

Citation: Kise NJ, Risber MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: A randomised controlled trial with two year follow-up. [Published online ahead of print July 20, 2016]. BMJ. doi:10.1136/bmj.i3740.

Commentary: We have known that patients with underlying knee osteoarthritis and a degenerative tear of their meniscus without mechanical symptoms fare just as well or better with physical therapy compared to surgical intervention. The interesting part about this study is that these patients had minimal to no radiographic evidence of underlying arthritis, were younger, leaner and more active than participants in other studies. Whether randomized into physical therapy, surgical intervention or cross-over into surgical intervention, everyone fared the same at the 2 years. The physical therapy commitment requested of both the surgical and non-surgical group was 2 to 3 times per week for 12 weeks. This is a large time commitment that clinicians should reference when setting up expectations for a patient’s recovery. This study supports that with some patience and dedication to a physical therapy program, time may heal all wounds, or at least work as well as surgical intervention. —Susan K. Fidler, MD