PHYSICAL THERAPY AFTER ARTHROSCOPIC PARTIAL MENISCECTOMY:  IS IT EFFECTIVE?  Exercise and Sport Sciences Reviews, Vol. 31, No. 2, April 2003.   

            Peter C. Goodwin                        Matthew C. Morrissey

ABSTRACT

In the UK, there are 5000 new cases of meniscal injury per year, and partial meniscectomy is the treatment option of choice when the problem does not resolve on its own.  After surgery, because of studies that have shown quadriceps atrophy/altered function/reduced knee quality of life, physical therapy is prescribed.  The purpose of this study was to review the articles in the current literature to determine if anything is able to truly support physical therapy after meniscectomy.

There were four categories of study that were found:

1. Physical therapy versus no treatment revealed 3 studies, with two supporting PT via improved isokinetic knee extensor strength in 3 weeks (versus 7-12 weeks in the control group), while another found improvement in return to sport activity, vertical and horizontal hop tests in the PT group.  A third study compared PT to NSAID therapy with a no-treatment control group, and found no differences.  These studies were limited by low patient numbers, no long term follow-up, no double blinding, and inequities of group characteristics at baseline.
2. The second category was physical therapy versus physical therapy plus an extra modality.  Here three studies looked at either ES for pain control, ES for strengthening, or SIT, which was stress inoculation training.  Here, all revealed an improvement in movement dysfunction, but no cost effectiveness study was performed.
3. Next was an immediate versus delayed treatment, which did not reveal any difference between groups.
4. The last was physical therapy versus alternative treatment, which consisted of home weight training, encouragement to return to sports, and advice.  Here, no difference was found between groups.

Based on the evidence from the studies used, there does not appear to be support for utilizing physical therapy after simple and uncomplicated knee meniscectomy.  There were some trends in the study towards increased strength and function, but nothing definitive and/or cost effective.

COMMENTS

Well, we really have nobody to blame but ourselves.  Physicians read this, realize there really is nothing to prove PT works, and may not use us.  In the case of partial meniscectomy, however, I agree that PT has limited usefulness.  The ortho surgeons by me do not routinely send patients over, and when they do, it is to speed up the process for some event.  There really does not seem to be a major benefit by using PT, and I have told many patients this when they tell me “I will be back after my surgery”.  I tell them probably not, unless they have a complication. 

The physicians are often reluctant to refer to PT due to many instances where the PT just aggravated the knee.  This is done usually by forced flexion, either with heel slides to increase ROM, or quad stretches.  After meniscectomy, full flexion puts significant shear forces across the meniscus and can aggravate the region of the tear.  Remember, the lateral meniscus moves up to 11mm from extension to full flexion.

Providing aggressive but safe PT may convince your physicians that PT is beneficial for their post-meniscectomy patients.  If you are able to do this, publishing something to support the program would benefit us all.