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Knee function improvement in patients with meniscus tears

What are the trajectories of improvement after treatment for degenerative meniscus tears?

Prognostic factors associated with worse knee function in sport and recreational activities after treatment for degenerative meniscus tears are both patient-related (e.g., higher BMI, poorer mental health, greater knee pain, lower perceived knee function, poorer quadriceps and hamstrings muscle strength, poorer functional performance) and imaging-based (e.g., more meniscal extrusion, radiological signs of knee osteoarthritis).

The percentages of patients showing low/ minimal, moderate/ gradual, and high/ early improvement are 10-12 percent, 20-36 percent and 53-70 percent, respectively. These results were found by a group of Scandinavian researchers who investigated the recovery trajectories of patient-reported knee function over five years after treatment for degenerative meniscal tears.

Three trajectories of patient-reported knee function were identified over the five-year follow-up period. The authors highlight that 90 percent of patients with degenerative meniscal tears show at least a gradual improvement two years after diagnosis, whether the management consisted of conservative or surgical treatment. Importantly, most of the factors identified to be associated with worse function are highly modifiable, and that should also be the focus of treatment.

> From: Berg et al., J Orthop Sport Phys Ther 51 (2021) 289-297 (Epub ahead of print). All rights reserved to Journal of Orthopaedic & Sports Physical Therapy. Click here for the online summary.

Want to read more? A free full text version of the paper is available here!

Expert opinion

Although 90 percent is a very encouraging figure, it should also be noted that what is being included in this percentage is “gradual” or better improvement at two years, and “gradual” may very well be unsatisfactory for many patients, especially those who expect to remain active.

One of the important aspects of this study was highlighting that many of the factors linked to poor function are modifiable. We have to be able to address these factors not only during the period in which we see the patient but also to encourage (and enable) them to keep addressing them in the long-term. This is important to avoid the treatment rollercoaster, in which the patient comes to treatment, improves, leaves treatment, deteriorates, and then returns to treatment.

By knowing which factors to focus on, it is easier to offer a more individualised approach which is more likely to lead to higher patient adherence and improved outcomes.

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