2017 ISAKOS Biennial Congress ePoster #1325

 

No Benefit of 12-Weeks Postoperative Treatment With Compartment-Unloading Knee Brace or -Insoles After Partial Meniscectomy

Dietmar Dammerer, Prof. Dr.med.univ., MSc, PhD, Krems AUSTRIA
Johannes M. Giesinger, PhD, Amsterdam NETHERLANDS
Florian Fischer, MD, Nürnberg GERMANY
Rene El-Attal, MD, Feldkirch AUSTRIA
Raul Mayr, MD, PhD, Innsbruck AUSTRIA
Dietmar Dammerer, Prof. Dr.med.univ., MSc, PhD, Krems AUSTRIA
Michael C. Liebensteiner, MD, PhD, Innsbruck, Tyrol AUSTRIA

Medical University of Innsbruck, Dept. of Orthopedics, Innsbruck, AUSTRIA

FDA Status Not Applicable

Summary

There is no benefit of a 12-weeks-postoperative unloading therapy (insole or brace) after partial meniscectomy in patients with degenerative meniscus tears.

Abstract

Background

There is consensus that patients after partial medial meniscectomy show increased varus kinematics and therefore increased varus load during gait (knee adduction moment). That progress in varus load after medial meniscectomy was identified a important promotor of degenerative knee joint disease. In the field of knee osteoarthritis compartment-unloading knee braces and wedged shoe insoles have a long tradition.
Therefore, it was speculated, whether a temporary postoperative unloading treatment after partial meniscectomy might also be beneficial. It was not possible to identify any scientific articles dealing with that specific issue. Consequently, we hypothesized that postoperative unloading treatment after partial meniscectomy would lead to significant statistical differences in the clinical outcome (knee specific outcome H1; physical activity H2).

Methods

Patients who underwent arthroscopic partial meniscectomy for degenerative meniscus tears as part of the clinical routine were enrolled. Exclusion criteria were: a) concomitant osteotomies b) medial meniscal lesion with valgus leg axis c) lateral meniscal lesion with varus leg axis d) 4° chondral lesions, e) osteoarthritis f) lesions of the collateral ligaments. The leg axis was determined as the mechanical femorotibial angle from weight-bearing whole leg radiographs. Patients were randomized to the following groups: 1) postoperative compartment-unloading brace (12 weeks) (valgus brace in medial meniscectomy and varus brace in lateral meniscectomy), 2) postoperative compartment-unloading wedge-insole (12 weeks) (lateral wedge in medial meniscectomy and medial wedge in lateral meniscectomy), 3) control group. Other intra- and postoperative aspects (surgical technique, physical therapie) were standardized.
As outcome parameter a typical knee score, appropriate for meniscal pathologies was applied (International Knee Documentation Committee, IKDC). In addition, the patient’s physical activity was determined with the Marx Score. Both scores were self-administered by the patients preoperatively, 6 weeks postoperatively, 12 weeks postoperatively and 6 months postoperatively.
Due to the small sample size of our preliminary results non-parametric tests were performed (Kruskal-Wallis, Friedman). For descriptive statistics Medians (Md) and Interquartil-Ranges (IQR) were calculated accordingly.

Results

The study population of 41 patients was comprised of 20 male and 21 female patients with an age of 53.0 ±17 (Md ±IQR). 14 were treated with an unloading brace, 14 with an unloading insole and 13 were in the control group. In 37 cases the partial meniscectomy was performed in the medial compartment and in 4 cases in the lateral compartment. At baseline, there were no inter-group differences regarding the IKDC or Marx activity Score.
For the entire study population the IKDC values changed over time from 50 preoperative to 64 at 6 weeks, 81 at 12 weeks and 79 at 6 months (p < 0.001, Friedman Test). Also the Marx - activity Score improved significantly over time (p < 0.01, Friedman Test). However, these improvements over time were expected and not linked to a study hypothesis.
With regard to our study hypothesis 1 there were no significant differences between the 3 groups in the IKDC score at any time point (preoperative, 6 weeks, 12 weeks, 6 months). Similarly, there were also no inter-group differences with regard to the Marx – activity Score at any time point

Hypothesis

2).

Conclusion

On the basis of our preliminary findings it is concluded that there is no benefit of a 12-weeks-postoperative unloading therapy (insole or brace) after partial meniscectomy in patients with degenerative meniscus tears.