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Meniscal surgery: pathology not related to pain and function

Does meniscal surgery help to improve symptoms?

There is no clinically relevant association between preoperatively reported knee pain and function and structural knee joint pathology recorded during surgery. This is the outcome of a study conducted in patients who underwent arthroscopic surgery for meniscal tears.

These results challenge the assumption that: 1) symptoms are related to structural pathology in the knee joint; and that 2) arthroscopic surgery for structural pathology is a means for improving patient-reported outcomes for some patients with knee pain and loss of function.

No clinically relevant association between preoperatively reported knee pain and function and structural knee joint pathology was found in patients who underwent arthroscopic meniscal surgery.

Synovitis explained a little portion of the variability of the patient-reported subscale for function in sports and recreation. A few patient characteristics (i.e. age, female gender, greater BMI) were slightly, yet consistently related to worse patient-reported outcomes.

> From: Tornbjerg et al., Br J Sports Med 51 (2017) 525-530 . All rights reserved to BMJ Publishing Group Ltd. Click here for the online summary.

Expert opinion

In this methodologically well-executed study with strict criteria for inclusion and exclusion, a large sample of patients was analysed. The results are noteworthy and can be seen in the light of a bigger movement, in which the association between tissue ?damage? and actual symptoms is being reevaluated and adjusted, and a more biopsychosocial perspective is adopted.

This is once again a caution for physiotherapists to be mindful in their communication and not emphasize a biomedical point of view, but rather stress that there might very well not be a relation between the medical imagery and their condition: what you see is not always what you get.

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