Dr Rimington is from the Department of Orthopedics, Georgetown University, Washington, District of Columbia; Dr Mallik is from the Department of Orthopedic Surgery, Medical College of Ohio, Toledo, Ohio; Dr Evans is from the Department of Orthopedic Surgery, Loyola University Chicago, and Dr Reider is from the Department of Orthopedic Surgery, University of Chicago, Illinois; and Dr Mroczek is from New York University Orthopaedic Surgery Associates, New York, New York.Drs Rimington, Mallik, Evans, Mroczek, and Reider have no relevant financial relationships to disclose. Financial support for the study was received from the University of Chicago Department of Orthopedics research fund.
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abstractFull article available online at OrthoSuperSite.com/view.asp?rID=41915This prospective study was designed to evaluate a nonoperative-based treatment protocol for patients with the clinical diagnosis of a degenerative medial meniscus tear and to determine if a significant percent of patients with degenerative medial meniscus tears improve with nonoperative treatment and do not elect operative treatment. Twenty-six patients were followed for 37 months and evaluated clinically, radiographically, and with standardized, validated Modified Lysholm Knee Scoring System (MLKS) and Standardized Activities of Daily Living Scale of the Knee (SADL) questionnaires. Patients were initially treated with 4 weeks of nonsteroidal anti-inflammatory drugs. After 4 weeks, they were offered arthroscopic partial meniscectomy or continued nonoperative treatment. Forty-six percent of patients (12 of 26) declined operative treatment. The mean length of time between enrollment and surgery was 3 months (range, 1-13 months). Both groups improved significantly over baseline (P<.05). The initial and final SADL and initial MLKS scores of the 2 groups were not significantly different (P>.05). The final MLKS score of the operative treatment group was significantly greater than the nonoperative group (P=.04). Both the nonoperative and operative treatment groups improved significantly at 3-year follow-up. Forty-six percent of the patients received nonoperative treatment and improved to a functional level that allowed them to avoid surgery. Therefore, we recommend an initial course of nonoperative treatment for all patients with a clinical diagnosis of degenerative medial meniscus tears prior to considering surgery.