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Temporary postoperative treatment with compartment-unloading knee braces or wedge insoles does not improve clinical outcome after partial meniscectomy
ESSKA Academy. Dammerer D. May 11, 2018; 218122; FP42-198
Dietmar Dammerer
Dietmar Dammerer
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Abstract
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Objectives: To investigate if temporary postoperative knee compartment unloading therapy after arthroscopic partial meniscectomy (APM) - with either knee braces or wedged insoles - would lead to superior clinical outcome compared to controls. This difference in clinical outcome was tested in terms of two knee scores (IKDS & KOOS), physical activity (MARX score) and general health outcome (SF-12) over the first postoperative year.

Methods: A randomized-controlled prospective design was applied. Patients who underwent APM as part of the clinical routine at our university hospital were considered for inclusion. Exclusion criteria were: 1) combined or staged surgical procedures 2) bicompartmental meniscectomy, 3) full thickness chondral lesions 4) rheumatoid arthritis or 5) osteoarthritis. The concept of unloading a recently partly resected medial meniscus was only regarded appropriate in case of a neutral or slightly varus leg axis. (The same for the lateral meniscus vice versa). Therefore, the patient's mechanical tibiofemoral angle (mTFA) was taken from a weight-bearing whole leg radiograph during bipedal stance at the time of enrollment. A knee with a mTFA from 2.9° varus to 2.9° valgus was defined as neutrally aligned. Knees beyond those varus or valgus mTFA values were defined as varus and valgus knees, respectively. Then the additional exclusion criteria 6) scheduled medial APM in a valgus knee and 7) scheduled lateral APM in a varus knee were applied.
APM was carried out as part of the clinical routine. Over a period of 12 weeks postoperative patients randomly underwent one of the following 3 treatments 1) compartment unloading knee brace, 2) compartment unloading wedge insole, 3) controls.
Outcome parameters were IKDC, KOOS, MARX and SF-12 which were collected preoperatively and postoperatively at 6 weeks, 12 weeks, 6 months and 12 months.
The study was powered to detect a two-way interaction of group-by-time (3 groups, 5 time points) in a repeated measure analysis of variance. An effect size of f=0.14 can be detected with beta=0.20, alpha=0.05, correlation among repeated measures is 0.70 and nonsphericity correction is 1.0 with a sample size of N=16 per group (N=48 in total). To account for an attrition rate of 30% we aimed at including N=63 at baseline. Power analysis was done with the software G*Power 3.1.9.2

Results: 56 patients were available for analysis (age 50.7 ± 11.6).
All outcome parameters showed significant improvement over time (not linked to a hypothesis). However, for none of the outcome parameters there were any significant group*time interactions meaning that the type of postoperative treatment was not related to the degree of improvement in the respective score.

Conclusions: It was concluded that 12 weeks of compartment unloading therapy - either with a knee brace or with wedged insoles - are ineffective with regard to the clinical outcome after APM. This applies to the knee score outcome, physical activity and general health outcome over the first year after APM.

Keywords:
meniscectomy, rehabilitation, knee brace, unloading, compartment, valgus, varus
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