In Patients with Meniscus Pathology, What is the Effect of Operative Treatment vs. Non-operative Treatment on Functional Improvements?
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Abstract
In patients with meniscus pathology, what is the effect of operative treatment vs. non-operative treatment on functional improvements?
Brooke Echter
Chelsey Kasel
Nora Kraemer
Brian Zeller
Clinical Scenario
Meniscus pathology such as degenerative tears and osteoarthritis complications have become more present in older adults. Surgical options, including meniscectomy or meniscal repairs, have less invasive techniques resulting in shorter recovery times; however, there is an option to avoid surgery and have comparable results. This research is aimed to identify whether surgery or conservative therapy is a more effective option for patients with degenerative meniscus pathology in improving function and decreasing pain.
Search Strategy
A literature review was conducted to determine operative vs. non-operative treatment outcomes for a meniscus tear on function and pain. The search terms included were meniscus tears, surgery, and physical therapy OR rehabilitation. The sources utilized with final hits for each include PubMed (50), CINAHL Plus (65), ProQuest Nursing Collection (629), and Cochrane Library (4).
The literature search yielded ten studies meeting the inclusion and exclusion criteria. Inclusion criteria were patients of all genders with degenerative meniscus tears who were 35+ years of age and active. Exclusion criteria included studies published before 2006 and traumatic meniscus tears.
Evidence Quality Assessment
Studies were assessed for quality by utilizing the PEDro scale. PEDro scores range from 7-10/11. The Oxford scale determined the level of evidence for each reviewed article. The Oxford scale was scored at a range of 2-3.
Results and Summary of Search:
The included studies assessed the association between clinical and self-reported knee function in patients with a degenerative meniscus tear.1-10 The studies utilized the following outcomes IKDC,2,10 VAS,2,4,7 Tegner activity scale,2,4 KOOS,3,5 Lysholm knee score,4,6,8,9 WOMET,6,8,9 and WOMAC.5,7
Though many of the articles supported the use of conservative methods initially after diagnosis,1-3,7,10 very few reported that surgical intervention was not required to return patients to a functional status.4-6,8,9 However, some studies that used conventional therapy before surgery provided post-surgical benefits to patients in terms of regaining lower extremity function.1,3,7
Despite the effectiveness of conservative therapy prior to surgery, several limitations are present within this research topic weakening the authors’ ability to answer the clinical question. Limitations included lacking control group,1-5,7 inability to blind all subjects,1-5,7 recording clinical results by separate assessors for each trial,1,4 small sample sizes,7 and experiencing crossover complications.3,5-7
Clinical Bottom Line
Based on the evidence appraised, conservative treatment can be considered before surgical treatment as a primary treatment option for patients with degenerative meniscal tears. If conservative treatment fails, then surgical intervention should be recommended. Due to the inconsistency, disease-orientation, and level of evidence of the articles reviewed, the SORT score is B.1-10
Implications for Practice, Education, and Future Research
This information can be generalized for middle-aged and older populations with degenerative meniscus tears, but not for those experiencing traumatic events or of a younger aged population.1-10 Further research should include longitudinal assessments incorporating follow-up periods greater than 2 years, larger sample sizes, and investigating the relationship between treatment methods and knee-osteoarthritis progression.4,5,7
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Nora Kraemer
Second Advisor/Mentor
Brian Zeller
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
In Patients with Meniscus Pathology, What is the Effect of Operative Treatment vs. Non-operative Treatment on Functional Improvements?
In patients with meniscus pathology, what is the effect of operative treatment vs. non-operative treatment on functional improvements?
Brooke Echter
Chelsey Kasel
Nora Kraemer
Brian Zeller
Clinical Scenario
Meniscus pathology such as degenerative tears and osteoarthritis complications have become more present in older adults. Surgical options, including meniscectomy or meniscal repairs, have less invasive techniques resulting in shorter recovery times; however, there is an option to avoid surgery and have comparable results. This research is aimed to identify whether surgery or conservative therapy is a more effective option for patients with degenerative meniscus pathology in improving function and decreasing pain.
Search Strategy
A literature review was conducted to determine operative vs. non-operative treatment outcomes for a meniscus tear on function and pain. The search terms included were meniscus tears, surgery, and physical therapy OR rehabilitation. The sources utilized with final hits for each include PubMed (50), CINAHL Plus (65), ProQuest Nursing Collection (629), and Cochrane Library (4).
The literature search yielded ten studies meeting the inclusion and exclusion criteria. Inclusion criteria were patients of all genders with degenerative meniscus tears who were 35+ years of age and active. Exclusion criteria included studies published before 2006 and traumatic meniscus tears.
Evidence Quality Assessment
Studies were assessed for quality by utilizing the PEDro scale. PEDro scores range from 7-10/11. The Oxford scale determined the level of evidence for each reviewed article. The Oxford scale was scored at a range of 2-3.
Results and Summary of Search:
The included studies assessed the association between clinical and self-reported knee function in patients with a degenerative meniscus tear.1-10 The studies utilized the following outcomes IKDC,2,10 VAS,2,4,7 Tegner activity scale,2,4 KOOS,3,5 Lysholm knee score,4,6,8,9 WOMET,6,8,9 and WOMAC.5,7
Though many of the articles supported the use of conservative methods initially after diagnosis,1-3,7,10 very few reported that surgical intervention was not required to return patients to a functional status.4-6,8,9 However, some studies that used conventional therapy before surgery provided post-surgical benefits to patients in terms of regaining lower extremity function.1,3,7
Despite the effectiveness of conservative therapy prior to surgery, several limitations are present within this research topic weakening the authors’ ability to answer the clinical question. Limitations included lacking control group,1-5,7 inability to blind all subjects,1-5,7 recording clinical results by separate assessors for each trial,1,4 small sample sizes,7 and experiencing crossover complications.3,5-7
Clinical Bottom Line
Based on the evidence appraised, conservative treatment can be considered before surgical treatment as a primary treatment option for patients with degenerative meniscal tears. If conservative treatment fails, then surgical intervention should be recommended. Due to the inconsistency, disease-orientation, and level of evidence of the articles reviewed, the SORT score is B.1-10
Implications for Practice, Education, and Future Research
This information can be generalized for middle-aged and older populations with degenerative meniscus tears, but not for those experiencing traumatic events or of a younger aged population.1-10 Further research should include longitudinal assessments incorporating follow-up periods greater than 2 years, larger sample sizes, and investigating the relationship between treatment methods and knee-osteoarthritis progression.4,5,7
