Public Defence: Nina Jullum Kise
MD Nina Jullum Kise at Institute of Clinical Medicine will be defending the thesis “Treatment of Degenerative Meniscal Tears in Middle-Aged Patients” for the degree of PhD (Philosophiae Doctor).
Trial Lecture – time and place
See Trial Lecture.
- First opponent: Professor Joanna Kvist, Linköping University
- Second opponent: Associate Professor Håkan Gauffin, Linköping University
- Third member and chair of the evaluation committee: Professor Jan Erik Madsen, University of Oslo
Chair of the Defence
Professor Jens Ivar Brox, University of Oslo
Professor May Arna Risberg, Norwegian School of Sport Sciences
Background: In orthopedic surgery, new knowledge has contributed to change of treatment algorithms. For patients with degenerative meniscal tears, the usual treatment has been arthroscopic partial meniscectomy (APM), but studies have shown similar results after exercise therapy (ET) or sham surgery.
Aim: The overall aim of this thesis was to determine if ET was superior to APM on knee function after 2 years. Secondary aims were to identify prognostic factors for outcomes.
Methods: 140 patients aged 35-60 years with degenerative meniscal tears were treated with either ET or APM. Main outcomes were 2-year KOOS4 score (mean score of 4 of 5 subscales from the Knee injury and Osteoarthritis Outcome Score) and 3-month thigh strength. Secondary outcomes were KOOS subscales and knee performance. In subgroups, prognostic factors of knee function, knee performance and activity level at baseline and meniscal tear characteristics, on 1- and 2-year outcomes were explored.
Results: Both treatment groups had clinically and statistically significant improvements for all KOOS outcomes at 2 years, and there were no between-group differences. After 3 and 12 months, the ET group had significantly better muscle strength. A better 6-meter timed hop test result at baseline was associated with better 2-year outcomes. Complex meniscal tears, meniscal extrusion, cartilage injury and larger meniscal excisions were associated with worse outcomes.
Conclusions: No differences in 2-year results for treatment of degenerative meniscal tears with ET or APM. Better knee function at baseline was a significant prognostic factor for better outcomes. Complex meniscal tears, meniscal extrusion, cartilage injury and larger excisions of meniscal tissue were prognostic factors for inferior outcomes. This implicates that ET should be recommended, at least as the primary treatment. Patients should be informed that better knee performance is a prognostic factor for better outcomes after 2 years.
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