Physiotherapy Is As Good As Surgery For Meniscal Tears

Last week Yahoo! News reported that physiotherapy was as good as knee surgery. The claims were based on results of a recent study by Jeffrey Katz, Professor of Medicine and Orthopedic Surgery at Harvard University. The randomised controlled trial involved symptomatic patients aged 45 years or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. They randomly assigned 351 patients to surgery and postoperative physiotherapy or to a standardized physiotherapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). The patients were evaluated at 6 and 12 months.

They did not find significant differences between the study groups in functional improvement 6 months after randomisation; however, 30% of the patients who were assigned to physiotherapy alone underwent surgery within 6 months. “Since both the patients who received physical therapy and those who received surgery had similar and considerable improvements in function and pain, our research shows … there is no single ‘best’ treatment. Patients who wish to avoid surgery can be reassured that physical therapy is a reasonable option, although they should recognize that not everyone will improve with physical therapy alone.” Katz said.

Having undergone a successful menisectomy last year I can personally attest that surgery can sometimes achieve results that physiotherapy can’t but conservative management such as physiotherapy should always be the first port of call.

Skiing And Snowboarding Injuries

A study by Suezie Kim et al. published in The American Journal of Sports Medicine has shown that injury rates in snowboarders are slightly higher than injury rates in alpine skiers. Snowboarders more commonly injure their wrists, shoulders and ankles while skiers tend to injure their knees.

In skiers the knee accounts for a third of all injuries but female skiers are twice as likely to injure their knees as men and 3 times as likely to strain their anterior cruciate ligaments (ACL). Gerhard Ruedl et al. found that women “showed a 2-fold higher risk of suffering an ACL rupture of their non-dominant leg”. Men had an equal chance of injuring the right or left knee. Ruedl told Reuters Health that women showed greater discrepancies in strength and proprioception (sense of joint positioning)  between their dominant and non-dominant legs. Most female skiers injured their left (non-dominant) ACLs during right turns when the forces on the left (outside) leg were greatest.