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

CATEGORY: MOBILITY, BONES & JOINTS

Ten years after treating a worn meniscal tear, middle-aged adults who had been assigned to a 12-week exercise program were doing just as well as those who had keyhole surgery: pain and knee function had improved in both groups with no clinically relevant difference between them, and knee arthritis had developed at nearly the same rate—23% after surgery versus 20% after exercise—in a randomized Norwegian trial published in the British Journal of Sports Medicine.¹ For one of the most common reasons for knee surgery, a full decade of follow-up found nothing the operation had added.

The Knee’s Shock Absorber, and Two Ways to Treat It

Each knee has two menisci—crescent-shaped pads of cartilage that sit between the thigh bone and the shin bone and work like shock-absorbing washers, spreading load so the joint’s smooth surfaces don’t 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—keyhole surgery in which the surgeon, working with a small camera through openings the width of a pencil, trims away the frayed portion. The alternative tested in this trial was exercise therapy: twelve weeks of supervised sessions built around strengthening the leg and steadying the knee, with no operation at all.

One Hundred Forty Knees, Assigned by a Coin Toss

The trial, known as OMEX, enrolled 140 adults with a degenerative meniscal tear and little or no sign of arthritis on X-ray. Each participant was assigned by chance to surgery or to the exercise program—the design that makes the two groups alike in everything except the treatment being tested, so whatever happens afterward can be credited to the treatment itself. Researchers then followed both groups for ten years, re-checking X-rays with a standard score that tallies narrowing of the joint space and the bony spurs arthritis leaves behind, and tracking participants’ own reports of pain and knee function alongside laboratory measurements of thigh-muscle strength.

Arthritis Arrived at Almost the Same Rate Either Way

On the X-ray score, arthritis progressed on average a shade more in the surgery group—a difference small enough to have been chance. New arthritis visible on X-ray, whether or not it caused symptoms, appeared in 23% of the surgery group and 20% of the exercise group over the decade: a gap of about three people in every hundred treated. On pain, daily function and muscle strength, the researchers found no clinically relevant differences at all. Both groups had improved from where they started, and a decade later the two sets of knees could hardly be told apart.

A Larger Dutch Trial Reached the Same Verdict at Five Years

The result does not stand alone. In the Netherlands, the ESCAPE trial ran the same comparison in 321 patients with degenerative tears and followed them for five years: knee function improved by 29.6 points in the surgery group and 25.1 points in the physical-therapy group on a 100-point scale, and that 3.5-point gap fell well inside the 11-point margin the researchers had set in advance as the smallest difference that would matter to a patient. Rates of new knee arthritis on X-ray were comparable there too.² Two randomized trials in two countries, one running five years and the other ten, landed on the same answer. Both trials studied worn, age-related tears—not the sudden tears of young athletes, which are a different injury treated on different evidence.

Key Takeaways

• In a 10-year randomized trial of 140 middle-aged adults with worn (degenerative) meniscal tears, keyhole surgery offered no advantage over 12 weeks of exercise therapy on pain, knee function or muscle strength.
• Knee arthritis appeared in 23% of the surgery group and 20% of the exercise group—about three more people per hundred treated, a difference small enough to be chance.
• A separate Dutch trial of 321 patients found physical therapy no worse than surgery on knee function five years on, well within the margin its researchers had set in advance.
• These findings cover worn, age-related meniscal tears, not acute sports tears in younger people.

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