For Worn Meniscus Tears, Exercise Therapy Held Its Own Against Keyhole Surgery

CATEGORY: MOBILITY, BONES & JOINTS

Ten years after treatment, middle-aged adults who did twelve weeks of exercise therapy for a worn meniscal tear were doing as well as those who had keyhole surgery. Pain and knee function improved in both groups, with no clinically relevant difference between them. Knee arthritis showed up at nearly the same rate: 23% after surgery, 20% after exercise. The Norwegian trial, published in the British Journal of Sports Medicine, followed 140 adults for a decade and found nothing the operation had added.¹

The Knee’s Shock Absorber, and a Gasket That Wears Out

Each knee carries two menisci. They are crescent-shaped pads of cartilage that sit between the thigh bone and the shin bone, working like shock-absorbing washers that spread load so the joint’s smooth surfaces do not grind on each other. In younger people a meniscus usually tears in an accident. In middle age it more often frays gradually, the way a rubber gasket wears out, which is why these are called degenerative tears. The standard operation is arthroscopic partial meniscectomy. A surgeon works a small camera through openings the width of a pencil and trims the frayed portion away. The alternative on test asked for no operation at all: twelve weeks of supervised sessions, built around strengthening the leg and steadying the knee.

A Coin Decided, and Then Came Ten Years of X-Rays

The trial is known as OMEX. It enrolled 140 adults who had a degenerative tear and little or no arthritis on X-ray, and a coin toss rather than the patient or the surgeon settled which treatment each one got. Both groups were followed for ten years. X-rays were re-read with a standard score that tallies narrowing of the joint space and the bony spurs arthritis leaves behind, alongside participants’ own reports of pain and function and laboratory measurements of thigh-muscle strength. On that X-ray score, arthritis progressed a shade more after surgery, by a margin small enough to have been chance. New arthritis visible on film turned up in 23% of the surgery group and 20% of the exercise group, about three people in every hundred treated. Pain, daily function and muscle strength came out with no clinically relevant difference at all.

A Larger Dutch Trial Landed Here Too, at Five Years

In the Netherlands, the ESCAPE trial ran the same comparison in 321 patients with degenerative tears and followed them five years. Knee function improved 29.6 points after surgery and 25.1 points after physical therapy on a 100-point scale. That 3.5-point gap sat well inside the 11-point margin its researchers had named in advance as the smallest difference a patient would care about, and new arthritis on X-ray was comparable too.² Both trials studied worn, age-related tears. The sudden tears of young athletes are a different injury, treated on different evidence.

Key Takeaways

• A decade out, keyhole surgery gave no advantage over twelve weeks of exercise therapy on pain, knee function or muscle strength among 140 middle-aged adults with worn meniscal tears.
• Knee arthritis appeared in 23% of the surgery group and 20% of the exercise group, a difference of about three people per hundred, well within the play of chance.
• These results cover worn, age-related tears, not acute sports tears in younger people. A separate Dutch trial of 321 patients found physical therapy no worse than surgery on knee function five years on.

References

1. Berg B, Roos EM, Englund M, et al. Arthroscopic partial meniscectomy versus exercise therapy for degenerative meniscal tears: 10-year follow-up of the OMEX randomised controlled trial. British Journal of Sports Medicine. 2025;59(2):91–98. link
2. Noorduyn JCA, van de Graaf VA, Willigenburg NW, et al. Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial. JAMA Network Open. 2022;5(7):e2220394. link