Randomised controlled trials (RCTs) and systematic reviews show that, in patients with degenerative meniscus tears, arthroscopic partial meniscectomy offers no clinically significant advantage over exercise therapy in the first two years. Long-term studies (3–5 years) confirm these findings. Whilst some studies find an increased risk of knee osteoarthritis or knee replacement following a partial meniscectomy, others show no clinically relevant difference in the progression of osteoarthritis. Despite evidence suggesting that non-surgical treatment is superior for degenerative meniscal tears, this has not yet led to a significant reduction in the number of meniscus operations. This study compared knee joint function 5 years after arthroscopic partial meniscectomy and exercise-based physiotherapy in patients with degenerative meniscal tears. The study also examined the progression of radiographic and symptomatic signs of knee osteoarthritis. The hypothesis was that, over a period of 5 years, exercise-based physiotherapy is not inferior to arthroscopic partial meniscectomy.

Arthroscopy is a minimally invasive surgical technique that enables doctors to examine the inside of a joint in order to make diagnoses and, where necessary, carry out treatments. The term ‘arthroscopy’ is derived from the Greek words ‘arthro’ (joint) and ‘skopia’ (observation). The procedure is frequently used for joint problems such as pain, swelling or restricted mobility.

During arthroscopy, the surgeon inserts a special instrument, the arthroscope, into the affected joint through a small incision in the skin. The arthroscope is a thin, tubular endoscope with a camera and a light source at the tip. The camera transmits high-resolution images from inside the joint to a monitor, enabling the surgeon to examine the joint’s structures, such as cartilage, tendons, ligaments and bones.

In many cases, the surgeon can also carry out necessary treatments during the arthroscopy by inserting additional instruments through further small incisions in the skin. Common arthroscopic procedures include the removal or repair of cartilage damage, the suturing or smoothing of meniscal tears, the removal of bone splinters or loose bodies, and the treatment of inflammation.

Arthroscopy is frequently performed on joints such as the knee, shoulder, hip, elbow, wrist and ankle. The advantages of arthroscopy over open surgery generally include less pain, shorter recovery times and a lower risk of complications, as it is less invasive.

The results of the 5-year follow-up of the ESCAPE study show that, in terms of knee joint function, exercise-based physiotherapy performs no worse than arthroscopic partial meniscectomy in patients with degenerative meniscal tears during the first five years of follow-up. The study showed comparable rates of osteoarthritis progression in both treatment groups. The improvements in knee function observed in the first two years persisted even after five years. The results are consistent with earlier studies, which also found no significant differences in radiological deterioration between the two treatment groups. Future research should focus on investigating the efficacy of exercise-based physiotherapy compared with no treatment, in order to strengthen clinical guidelines and promote the use of arthroscopic partial meniscectomy for degenerative meniscal tears.

Noorduyn, Julia C. A.; van de Graaf, Victor A.; Willigenburg, Nienke W.; Scholten-Peeters, Gwendolyne G. M.; Kret, Esther J.; van Dijk, Rogier A. et al. (2022): Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomised Clinical Trial. In: JAMA Network Open 5 (7), e2220394. DOI: 10.1001/jamanetworkopen.2022.20394.