Meniscus injuries are frequent, and the operation to repair the meniscus has been one of the most frequently performed orthopaedic operations in Denmark over the past twenty years. Meniscus injuries among young people occur especially in contact sports such as handball and football. 

Researchers from Aarhus University, Aarhus University Hospital, the University of Southern Denmark and a number of orthopaedic surgery departments at Danish hospitals, have conducted a study in which they compared treatment with training and patient education and surgery to repair meniscus injuries among 121 young people. 

The study shows that the effect of an operation is not better than training and education.

"Meniscus injuries are a frequent knee injury and we’ve lacked knowledge about how best to treat young people. Knee injuries can have major consequences both in the short and long term. This is why it’s important that we now know that there are other effective treatments to choose from," says Martin Lind, professor, department chair at Aarhus University and professor at Aarhus University Hospital, who is one of the researchers behind the study.

Training and education have a good effect

The patients were divided into two groups. One group underwent an operation, while the other completed a twelve week supervised training programme, which consisted of two weekly training sessions with strength and coordination training and education about the injury and relevant stress-strain strategies. A quarter of the patients in the training group also ended up undergoing surgery.

After twelve months, the researchers followed up on the patients' levels of pain, function and quality of life, and the results showed that both groups had improved significantly, and that the group that had undergone surgery had not experienced a greater effect than the group that had undergone the training programme. 

The results have been published in the New England Journal of Medicine.

In the short term, a meniscus injury often leads to an absence from work or education. Studies also show that the risk of osteoarthritis 15 years after a ligament or meniscus injury is fifty percent, and that only half of the patients can return to playing sport at the same level as before. According to Martin Lind, it is therefore important that the patients receive the treatment that is best for them. And this can both be targeted training and education and/or surgery.

Young people manage well without surgery

"Established treatments are difficult to alter, and an operation is often the first choice to treat meniscus injuries. We hope that our study can lead to patients and clinicians, both general practitioners and orthopaedic surgeons, becoming more aware that there are several possible forms of treatment," says Martin Lind, and stresses that the findings are particularly interesting, because among young patients with a meniscus injury, there are some who do well without undergoing an operation.

"As with many other diseases and injuries, the choice of the right treatment is often a question of a number of different factors. With this study, we’ve shown that surgery is still a significant form of treatment for many of these patients, but that the decision to undergo surgery or not, isn’t always given in advance. There is a basis for further studies, so that over time we can offer even more individualised treatment," explains the researcher.

Orthopaedic surgeons from Amager-Hvidovre Hospital, Aalborg University Hospital, Hospital Lillebælt, Silkeborg Regional Hospital, Næstved Hospital and Odense University Hospital participated in the study.

"We’re continuing our research in this area, and are currently in the process of investigating whether we can use MRI scans of patients two years after a meniscus injury to see signs of osteoarthritis, and whether there are any differences between the scans of the patients who have been operated on and those who have completed the training programme. Our goal is to be able to show whether one or other treatment is better at preventing osteoarthritis later in life," says Martin Lind.

About the study

• The study is a clinical study.
• The study was conducted in a collaboration between Aarhus University, Aarhus University Hospital, the University of Southern Denmark and a number of orthopaedic surgical departments at Danish hospitals.
• The study is published in NEJM Evidence 25 January 2022.
• The study is financed by; The Independent Research Fund Denmark; The IMK Almene Fond; The Lundbeck Foundation; The Spar Nord Foundation; Næstved, Slagelse and Ringsted Hospitals’ Research Pool; Region Zealand (Exercise First); the Danish Arthritis Association; and the Danish Physiotherapy Association.

Contact

Professor, department chair Martin Lind
Aarhus University, Department of Clinical Medicine and
Aarhus University Hospital, Department of Orthopaedic Surgery
Mail: martinlind@clin.au.dk
Mobile: (+45) 3024 8244