Knee OA - Research Suggests Use Exercise First

Knee osteoarthritis (OA) affects more than 250 million people around the world and is an important factor contributing to a loss of early lifestyle and later independence. In 2013, arthritis and musculoskeletal conditions are one of the national health priority areas in Australia. In association with knee OA, meniscal tears are very prevalent, with the medial compartment most commonly affected.

Arthroscopic knee procedures are common in Australia with over 100,000 performed annually. These are predominately to address meniscal and arthritic problems.

Katz et al 2013 (1) examined 351 symptomatic patients, 45 years of age or older with a meniscal tear and imaging evidence of mild-to-moderate knee osteoarthritis. The primary outcome measure was the physical-function scale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The study was randomized and conducted over seven centres.

Participants were allocated to surgery and physiotherapy (called physical therapy in USA) program or only a physiotherapy program, usually of 6 weeks duration. The three-stage structured physiotherapy program was designed to address inflammation, range of motion, concentric and eccentric muscle strength, muscle-length restrictions, aerobic conditioning (e.g., with the use of a bicycle, or elliptical machine), functional mobility and proprioception.

The study was designed as a crossover and 30% of patients initially assigned to the physiotherapy group crossed over to the surgery in the first 6 months. This was because of insufficient initial improvement. The other 70% completed the study with no significant difference in outcome measures measured at 6 months, compared to those of the surgery group.

The paper concluded, “there were no significant differences in the magnitude of improvement in functional status and pain after 6 and 12 months between patients assigned to arthroscopic partial meniscectomy with postoperative physical therapy and patients assigned to a standardized physical therapy regimen.”

This study strengthens the evidence-based protocol for clients with a degenerative meniscal tear and mild to moderate OA, that the first line of management offered should be a 6-week structured exercise program, and if there is insufficient improvement a surgical review is appropriate.

Esperance Physiotherapy offers individualised assessments and exercise programs based upon these guidelines and will also often include hydrotherapy in the early stages and suggestions on appropriate braces and footwear.

Reference:
1.        Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, Donnell-Fink LA, Guermazi A, Haas AK, Jones MH, Levy BA, Mandl LA, Martin SD, Marx RG, Miniaci A, Matava MJ, Palmisano J, Reinke EK, Richardson BE, Rome BN, Safran-Norton CE, Skoniecki DJ, Solomon DH, Smith MV, Spindler KP, Stuart MJ, Wright J, Wright RW, and Losina E. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine 368: 1675-1684, 2013.