Administration of corticosteroid injection for treatment of degenerative meniscus tears helps increase perceived benefit from the initial phase of physical therapy.
Poster #: 085
Session/Time: B
Author:
Zachary Ross Krumm, BS
Mentor:
Kevin Bonner, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Meniscus tears are a common injury to the knee that can cause debilitating pain and symptoms. While sometimes these meniscus tears are repairable, many meniscus tears are more degenerative and cannot be repaired. In the case of degenerative, non-repairable meniscus tears (DMT), arthroscopy can be used to shave out unhealthy tissue; however, a non-operative approach with physical therapy and corticosteroids is often successful in relieving pain and symptoms. Studies have demonstrated the efficacy of both corticosteroid and physical therapy in isolation. This study aims to examine the efficacy of corticosteroid injections when followed by physical therapy to determine if injections provide benefit beyond what physical therapy provides for patients with DMT.
METHODS:
This study is a double-blind randomized control trial of a patient cohort aged between 35-70 with evidence of non-repairable DMT on MRI. Patients screened for candidacy based on having MRI findings of meniscus tear, appropriate age, no more than KL Grade 2 radiograph findings, and no prior surgical history on the affected knee, no diabetes, no concomitant ligamentous injury, no repairable meniscus tear, no physical therapy nor injection in the prior 3 months, no bucket handle meniscus tear, no locking of the knee, no known inflammatory arthritis, no open wounds, and no previously established allergy to corticosteroid injections. Patients were given informed consent and randomized into either an injection or saline category. To assess patient outcomes, an initial KOOS and Pain survey was administered. Subsequently, KOOS, Pain survey, and Patient perceived benefit surveys were administered at 4-8 week follow up, 3 months, 6 months, 1 year, and 2 years post injection. All collected data was analyzed ANOVA for equal variance findings or t-test for unequal variance findings on the JMP platform using an alpha=.05.
RESULTS:
13 patients have been recruited thus far to the study (Average age 54.8 4.3 years, 9 (69%) Males, 4 (31%) Females, 4 (31%) right knee, and 9 (69%) left knee). Randomization has resulted in 8 patients (62%) receiving corticosteroid injection and 5 patients (38%) receiving saline injection. There was no difference between injection groups for baseline survey data. On follow up surveys, the 4-8 week Perceived Benefit from Physical Therapy demonstrated a that the corticosteroid injection group saw greater benefit from physical therapy than the saline injection group (p=.048). No other significant findings were demonstrated on follow up surveys.
CONCLUSION:
This RCT preliminarily demonstrates that the use of corticosteroid injections may provide an acute benefit to patients receiving physical therapy for non-repairable degenerative meniscus tears among a homogenous group of participants. Because this finding is only present in the initial follow up, the data may suggest that corticosteroid injection assist patient with the initial aspects of physical therapy. While there were some significant findings, this study has a low number of patients enrolled and is likely underpowered. These results are preliminary, and we anticipate that further findings will reflect the current findings.
Meniscus tears are a common injury to the knee that can cause debilitating pain and symptoms. While sometimes these meniscus tears are repairable, many meniscus tears are more degenerative and cannot be repaired. In the case of degenerative, non-repairable meniscus tears (DMT), arthroscopy can be used to shave out unhealthy tissue; however, a non-operative approach with physical therapy and corticosteroids is often successful in relieving pain and symptoms. Studies have demonstrated the efficacy of both corticosteroid and physical therapy in isolation. This study aims to examine the efficacy of corticosteroid injections when followed by physical therapy to determine if injections provide benefit beyond what physical therapy provides for patients with DMT.
METHODS:
This study is a double-blind randomized control trial of a patient cohort aged between 35-70 with evidence of non-repairable DMT on MRI. Patients screened for candidacy based on having MRI findings of meniscus tear, appropriate age, no more than KL Grade 2 radiograph findings, and no prior surgical history on the affected knee, no diabetes, no concomitant ligamentous injury, no repairable meniscus tear, no physical therapy nor injection in the prior 3 months, no bucket handle meniscus tear, no locking of the knee, no known inflammatory arthritis, no open wounds, and no previously established allergy to corticosteroid injections. Patients were given informed consent and randomized into either an injection or saline category. To assess patient outcomes, an initial KOOS and Pain survey was administered. Subsequently, KOOS, Pain survey, and Patient perceived benefit surveys were administered at 4-8 week follow up, 3 months, 6 months, 1 year, and 2 years post injection. All collected data was analyzed ANOVA for equal variance findings or t-test for unequal variance findings on the JMP platform using an alpha=.05.
RESULTS:
13 patients have been recruited thus far to the study (Average age 54.8 4.3 years, 9 (69%) Males, 4 (31%) Females, 4 (31%) right knee, and 9 (69%) left knee). Randomization has resulted in 8 patients (62%) receiving corticosteroid injection and 5 patients (38%) receiving saline injection. There was no difference between injection groups for baseline survey data. On follow up surveys, the 4-8 week Perceived Benefit from Physical Therapy demonstrated a that the corticosteroid injection group saw greater benefit from physical therapy than the saline injection group (p=.048). No other significant findings were demonstrated on follow up surveys.
CONCLUSION:
This RCT preliminarily demonstrates that the use of corticosteroid injections may provide an acute benefit to patients receiving physical therapy for non-repairable degenerative meniscus tears among a homogenous group of participants. Because this finding is only present in the initial follow up, the data may suggest that corticosteroid injection assist patient with the initial aspects of physical therapy. While there were some significant findings, this study has a low number of patients enrolled and is likely underpowered. These results are preliminary, and we anticipate that further findings will reflect the current findings.