Comparison of physical therapy and arthroscopic partial meniscectomy treatments in degenerative meniscus tears and the effect of combined hyaluronic acid injection with these treatments: A randomized clinical trial

J Back Musculoskelet Rehabil. 2021;34(5):767-774. doi: 10.3233/BMR-200284.

Abstract

Background: Symptomatic degenerative meniscus tears are common in middle and old age. Arthroscopic partial meniscectomy (APM), physical therapy (PT) and hyaluronic acid injection (HAI) are the most commonly used treatment options.

Objectives: The aim of our study is to compare the effectiveness of APM and PT in degenerative meniscus tears and to investigate the effect of HAI with a prospective, randomized, single-blind study.

Methods: The study included 192 patients with symptomatic degenerative meniscus tears. The patients were randomly divided into the four groups. The first group consisted of patients who underwent APM, the second group received HAI with APM, the third group received PT, and the fourth group received HAI with PT. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS) scores, and range of motion (ROM) values were used for evaluation.

Results: There was no difference between four groups according to age, gender, BMI, affected side, grade of osteoarthritis. In the 4 groups, WOMAC and VAS results at the 2nd and 6th months were better than pre-treatment. There was no difference between the groups in terms of WOMAC and VAS. In terms of ROM, the results were found better in PT group (Group 3, Group 4) at the 2nd and 6th months. However, the results were found worse in APM group (Group 1, Group 2). In addition, it was found that HAI applied with APM and PT had no effect on VAS, WOMAC, and ROM. It was determined that the increase of knee osteoarthritis negatively affected both the results of APM treatment and PT. VAS, WOMAC, and ROM results were found worse in patients with stage 3 osteoarthritis than grade 1 and 2, but there was no difference between grade 1 and 2.

Conclusions: APM and PT give good results in terms of pain and functional results. However, ROM limitation develops after APM. Conversely, there is an increase in ROM after PT. Administration of HAI with these treatments has no effect on the results. PT is an easily applicable noninvasive method. Adding HAI to the treatment has no effect on the results and increases the cost.

Keywords: Degenerative meniscus tears; arthroscopic partial meniscectomy; hyaluronic acid; physical therapy.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Arthroscopy
  • Humans
  • Hyaluronic Acid / therapeutic use
  • Meniscectomy
  • Meniscus*
  • Osteoarthritis, Knee* / drug therapy
  • Osteoarthritis, Knee* / surgery
  • Physical Therapy Modalities
  • Prospective Studies
  • Single-Blind Method
  • Tibial Meniscus Injuries* / surgery
  • Treatment Outcome

Substances

  • Hyaluronic Acid