Table 3 Evidence for conservative therapy

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