Traumatic meniscal tears are most common in younger people below the age of 30. They tend to occur in sports like football and rugby which involve making sudden twisting movements with the knee bent. The force of this on the knee can cause the meniscus – which cushions the bones of the knee and prevents them from rubbing together – to tear.
Symptoms of traumatic meniscal tears
The result is pain and swelling, with patients often unable to put weight on the affected knee. If the meniscal tissues become displaced, the knee may lock in a bent position or there may be a painful clicking sensation within the joint. The knee may feel weak and unstable, as though it might give way at any moment.
Diagnosing a traumatic meniscal tear
If you sustain a traumatic meniscal tear, you may experience immediate swelling and be unable to put weight on the affected leg. Or the pain and swelling may develop more slowly if the tear occurs in a part of the knee that has limited or no blood supply. An MRI scan will show the location and severity of the tear and your orthopaedic surgeon will discuss the most effective treatment.
Arthroscopic partial meniscectomy or physiotherapy?
Treatment for traumatic meniscal tear may vary. If the knee is locked, it normally requires emergency surgery to repair the torn meniscus or remove it (known as an arthroscopic partial meniscectomy). If the knee is not locked, the meniscal tear may be left to heal on its own, with physiotherapy to support recovery, sometimes followed by arthroscopic partial meniscectomy at a later date.
Rotterdam study
A recent study at the Erasmus MC University in Rotterdam compared arthroscopic partial meniscectomy with physiotherapy in patients aged 45 and under who had sustained a traumatic meniscal tear. Some of the patients who had physiotherapy subsequently went on to have an arthroscopic partial meniscectomy.
Researchers carried out a multi-centre, open-labelled, randomised controlled trial among patients aged 18 to 45. All of them had an isolated meniscal tear, verified by MRI scan, without knee osteoarthritis. Patients were randomised to those who had undergone arthroscopic partial meniscectomy and those who had received standardised physiotherapy, with an optional delayed arthroscopic partial meniscectomy after three months of follow-up.
Cost-utility analysis
A cost-utility analysis compared the two groups over 24 months from both a healthcare system perspective and a societal perspective. The cost utility was calculated according to incremental costs per quality-adjusted life year (QALY) gained when comparing arthroscopic partial meniscectomy against physiotherapy.
One hundred patients were included in the study – 49 who had received an arthroscopic partial meniscectomy and 51 who’d received physiotherapy. Amongst the latter group, 41% (21 patients) had gone on to receive a delayed arthroscopic partial meniscectomy during the follow-up period.
Findings
The researchers found that over a two-year period, patients who’d had an arthroscopic partial meniscectomy had a lower quality of life of an average of 0.005 QALYs. The cost-utility ratio was 160,000 Euros per QALY from a healthcare perspective and 223,372 Euros per QALY from a societal perspective. In other words, the arthroscopic partial meniscectomy incurs additional costs without providing any added health benefits.
They concluded from this that this type of surgery is unlikely to be cost-effective when treating younger patients with isolated traumatic meniscal tears when compared against physiotherapy. The quality of life outcomes are similar for both arthroscopic partial meniscectomy and physiotherapy (with optional delayed arthroscopic partial meniscectomy). However, the former is more costly.
Based on the Rotterdam study, unless the knee is locked, in which case emergency surgery is needed, physiotherapy is likely to provide the best results for traumatic meniscal tears, with the option of delayed arthroscopic partial meniscectomy after three months.
We can help
If you have sustained a traumatic knee injury and require advice about diagnosis or treatment, contact us for an initial consultation and we can start the process of understanding your injury and recommending the most effective treatment plan.
