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Table 3 Evidence for conservative therapy

From: Meniscal pathology - the evidence for treatment

Study Study description Group 1 Group 2 Group 3 Group 4 Outcome measure Results Conclusion
Physical therapy        
Yim and colleagues, 2013 [16] Degenerative horizontal tear of posterior horn of medial meniscus on MRI; mean age 53.8 years (range 43 to 62 years); 2-year follow-up APM, n = 50 Strengthening exercises, n = 52 N/A N/A Symptoms Both groups reported an improvement in knee pain, function and a high level of treatment satisfaction using VAS, LKS, Tegner activity scale, patient subjective knee pain and satisfaction. No significant between-group differences APM not superior to strengthening exercises in terms of improved knee pain, function or treatment satisfaction
Katz and colleagues, 2013 [15] Symptomatic meniscal tear; age ≥45 years; 6-month and 12-month follow-up APM and postoperative PT, n = 161; mean age 59.9 ± 7.9 years PT alone, n = 169; mean age 57.8 ± 6.8 years N/A N/A Symptoms WOMAC at 6 and 12 months: improvement in both groups but no between-group differences; 30% crossover from PT alone within first 6 months PT non-inferior to APM + PT for pain reduction
Herrlin and colleagues, 2013 [17] Symptomatic medial meniscal tear and radiographic OA; 24-month and 60-month follow-up APM followed by exercise therapy for 2 months, n = 47; median age 54 years Exercise therapy alone, n = 49; median age 56 years N/A N/A Symptoms Clinical improvement from baseline to the follow-up in both groups on all subscales of KOOS, LKS and VAS (P <0.0001). One third of exercise-alone patients that failed to respond had a benefit from then having APM Exercise alone non-inferior to APM + exercise
Herrlin and colleagues, 2007 [14] Knee pain and underlying OA with medial meniscal tear; mean age 56 years; 8-week and 6-month follow-up APM and supervised exercise, n = 47 Supervised exercise alone, n = 43 N/A N/A Symptoms Both groups reported decreased knee pain, improved function and high satisfaction. No between-group differences Exercise alone non-inferior to APM + exercise
Beidert, 2000 [10] Painful intrasubstance medial meniscal tear; mean age 30.4 years (range 16 to 50 years); 26.5-month follow-up APM, n = 11 Suture repair, n = 10 Minimal resection, fibrin clot, suture repair, n = 7 PT and NSAIDs, n = 12 Symptoms Normal/near-normal IKDC. Group 4, 75%; Group 2, 90%; Group 3, 43%; Group 1, 100% APM superior to conservative therapy
Weight loss        
Teichtahl and colleagues, 2013 [34] No previous diagnosis of knee OA; recruited from weight-loss clinics; mean age 45.7 years; 2.4-year follow-up Medial meniscal tear on MRI, n = 36; mean age 51.0 ± 7.5 years No medial meniscal tear on MRI, n = 161; mean age 45.8 ± 8.9 years N/A N/A Structure. Symptoms In people with medial meniscal tears: every 1% change in weight associated with change in medial tibial cartilage volume (95% CI 0.1 to 0.3%, P <0.001) and change in WOMAC knee pain (95% CI 2.1 to 21.1, P = 0.02) Weight loss associated with reduced cartilage loss and improved pain only in people with medial meniscal tears. Weight gain increased cartilage loss and knee pain
  1. APM, arthroscopic partial menisectomy; CI, confidence interval; MRI, magnetic resonance imaging; N/A, not available; NSAID, nonsteroidal anti-inflammatory drug; OA, osteoarthritis; PT, phsycal therapy. Western Ontario and McMaster Universities Arthritis Index (WOMAC) evaluates the condition of patients with osteoarthritis of the knee and hip, including pain, stiffness, and physical functioning of the joints. Knee Injury and Osteoarthritis Outcome Score (KOOS) evaluates short-term and long-term patient-related outcomes following injury including pain, other symptoms such as catching/locking/swelling, activities of daily living, sport and recreation function, and knee-related quality of life. Lysholm knee scoring (LKS) scale for knee ligament injuries including pain, swelling, locking, limping, stair climbing, support and squatting. Visual analogue scale (VAS) is a subjective measurement of pain consisting of a line 10 cm long where on one end is ‘no pain’ and on the other is the ‘worst pain imaginable’. International Knee Documentation Committee score (IKDC) is a score to evaluate knee ligament injuries including three domains of symptoms (pain, locking, catching, swelling, stiffness), sports and daily activities and current knee function (compared with old knee function).