Meniscectomy vs physio for meniscal tears with Dr Travis Pollen
May 3, 2023
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Dr Travis Pollen, a personal trainer with a PhD in Rehabilitation Sciences, discusses a research review comparing meniscectomy and physiotherapy for meniscal tears in younger patients. Results show similar outcomes at two years, raising questions about the role of surgery. The podcast explores the study's methodology, interpretations of the results, impact on return to sport, and the importance of giving physical therapy a thorough trial before considering surgery.
The study found that both surgery and physical therapy resulted in similar outcomes for young patients with traumatic meniscal tears, suggesting surgery may not always be necessary.
Individual factors and preferences should be considered when deciding on the treatment approach for patients with traumatic meniscal tears, as some individuals may still require surgical intervention even after attempting physical therapy.
Deep dives
Comparison of Surgery and Physical Therapy Outcomes
The podcast discusses a research study that compared the outcomes of arthroscopic partial menisectomy with physical therapy for young patients with traumatic meniscal tears. The study found that both groups had similar scores on the International Knee Documentation Committee (IKDC) scale at the end of the two-year study period. Although those who initially received surgery had lower scores in the preliminary time points, all participants ended up with similar outcomes at the 24-month mark. The study suggests that surgery may not always be necessary for this population, but individual factors and preferences should be considered when deciding on the treatment approach.
Patient Selection and Treatment Protocol
The study included patients aged 18 to 45 with traumatic meniscal tears. In order to participate, patients had to have a full tear based on MRI findings and were excluded if they had a locked knee or concurrent ACL/PCL tear. The participants were allocated randomly into two groups: surgery and physical therapy. The surgery group underwent arthroscopic partial menisectomy, while the physical therapy group received at least three months of physical therapy. Interestingly, 41% of the physical therapy group ended up getting the surgery at a later stage. The study did not focus on time to return to sport, but it included a diverse range of patients, including competitive athletes.
Interpretation of the Study Findings
The study findings can be interpreted in different ways. Optimistically, the results show that nearly 60% of the participants who received physical therapy achieved the same outcomes as those who underwent surgery. This suggests that surgery may not be necessary for all patients with traumatic meniscal tears. However, pessimistically, 41% of the physical therapy group eventually opted for surgery, implying that some individuals may still require surgical intervention. The study highlights the need for identifying factors that determine the success of physical therapy versus surgery, as not all patients respond equally to these treatments. Clinicians may consider starting with physical therapy and reevaluating the need for surgery based on individual progress and preferences.
In this episode, Dr Travis Pollen takes us through a recent research review he did for Physio Network exploring younger patients with a traumatic mensical injury. We look at the results of a recent paper comparing those who had surgery and those who had physiotherapy. Interestingly the results at two years were very similar but this opened up a lot of questions and nuance about what happens within that two years.
Dr Travis Pollen is a personal trainer and has a PhD in Rehabilitation Sciences (Drexel University). He also holds a master’s degree in Biomechanics and Movement Science (University of Delaware). His research interests focus on movement screening, injury risk appraisal, and return to play testing in athletes.
van der Graaff et al (2022) Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial. British Journal of Sports Medicine, 56, 870-876.
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Our host is Michael Rizk from Physio Network and iMoveU
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