Surgery No Better Than Exercise for Knee Damage

Exercise is at least as effective as surgery for middle-aged patients with a common type of knee injury known as a meniscal tear.

That’s the upshot of new research published in The British Medical Journal (BMJ) that challenges conventional medical approaches that favor surgery to repair such tears, which involve damage to the rubbery discs that cushion the knee joint.

The researchers, based in Denmark and Norway, suggest that supervised exercise therapy should be considered as a treatment option for middle-aged patients with this type of knee damage before surgery, if they don't also have arthritis.
 
“Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term,” said the researchers. “Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no radiographic evidence of osteoarthritis to consider supervised structured exercise therapy as a treatment option.”

Every year, two million people worldwide undergo knee arthroscopy (keyhole surgery to relieve pain and improve movement) at a cost of several billion dollars. Yet current evidence suggests that arthroscopic knee surgery offers little benefit for most patients.
 
For the new study, researchers compared exercise therapy alone with arthroscopic surgery in 140 people (average age: 50 years) with degenerative meniscal tears.
 
Half of the patients engaged a supervised exercise program over 12 weeks (two to three sessions each week) and the other half underwent arthroscopic surgery followed by simple daily exercises to perform at home.
 
After two years, the researchers found no differences between the two groups for outcomes such as pain, function in sport and recreation, and knee-related quality of life. But as early as three months after the study started, muscle strength had improved more in the exercise group than among those who underwent surgery.
 
“Essentially, good evidence has been widely ignored,” said Teppo Järvinen at the University of Helsinki and Gordon Guyatt at McMaster University in Canada, explaining how surgery became the treatment of choice for meniscal tears.
 
“In a world of increasing awareness of constrained resources and epidemic medical waste, what we should not do is allow the orthopedic community, hospital administrators, healthcare providers, and funders to ignore the results of rigorous trials and continue widespread use of procedures for which there has never been compelling evidence.”