Friday, March 1, 2013

Non Operative Treatment for Meniscus Tears

Study confirming successful non-operative treatments for meniscus tears...

The best available evidence from our search consisted of a retrospective review (1), a prospective clinical trial (2), and a randomized trial (3).

Lim et al performed a retrospective chart review among 30 mostly female patients who completed non-operative treatment for degenerative posterior root tear of the medial meniscus (1). Treatment consisted of supervised therapy, exercises, and NSAIDs for 8-12 wks (1). The authors concluded that clinical outcomes of self-reported pain and function improved during the follow-up period, an average of 36 mos (1). However, the study is limited in that the design did not allow for blinding of participants or a control group.

Rimington et al conducted a prospective trial among 26 patients with degenerative medial meniscus tear, comparing non-operative treatment consisting of NSAIDs to operative treatment (2). Almost half of patients improved with non-operative treatment, while remainder did not improve and chose to undergo operative treatment (2). At conclusion of treatment, subjects in both groups showed improved pain and function as assessed by questionnaire (2). Of note, a greater percentage of men elected surgery compared to women (72% vs 13%) (2). Limitations of this study include a lack of randomization, possibility of selection bias, and treatment until improvement was demonstrated on primary outcomes.

Herrlin et al randomized 90 middle-aged patients with degenerative medial meniscal tears to surgery followed by 8 wks of exercise or exercise alone, and found similar improvements in patient questionnaires for pain, function, symptoms, and activity (3). Limitations of this study include lack of blinding and no control group.

Based on this review, it can be concluded that non-operative management of meniscal tears shows promise in achieving successful clinical outcomes in a large percentage of the patients, and should be considered as the initial treatment approach. Sample exercises from VHI PC-Kits have been provided based on information from these articles.

Dr. Joshua Brooks
Chiropractor, Falls Church VA 22046

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