Wednesday, March 12, 2008

To Run or Not to Run: A guideline for post-menisectomy patients

A recent review in the Journal of Manual and Manipulative Therapy explores the following questions regarding menisectomy, risk for osteoarthritis, and recreational running. Through a comprehensive search of available literature on the issue, the author of the article Bob Baumgarten attempts to address the following questions :
  1. Is it advisable for individuals to continue recreational running following menisectomy?

  2. Are there identifiable risk factors physical therapists can use to identify patients likely to develop OA following a menisectomy?

The review highlights several key relationships that may shed light on the answers to these questions. Specifically, Baumgarten examines the relationships between:

  • Anatomy and functional role of the meniscus

  • Etiology and classification of osteoarthritis

  • Diagnostic measures of osteoarthritis

  • Recreational running and osteoarthrits

  • Menisectomy and OA

Baumgarten concludes that there is likely an elevated risk for early onset of OA in a post-menisectomy population. However, it is premature to declare this risk a certainty. He goes on to state there is insufficent high-level evidence to suggest concret clinical guidelines for recreational runners following menisectomy.

Some general guidelines however may assist the provider in decision making regarding their patients who are considering a return to running. Risk factors for early development of osteoarthritis include:

  • Greater than 1/3 of the meniscus removed during menisectomy

  • Preexisting articular cartilage degeneration

  • Degenerative vs traumatic meniscal injury

  • Gender (females > males)

  • BMI equal to or greater than 30

  • Lateral compartment involvement

  • Genu valgum or varum with lateral or medial menisectomy respectively

Patients possessing fewer risk factors may be at lower relative risk for developing early symptomatic osteoarthritis arthritis. Based on the author's findings, it may be advisable to recommend patients with a higher number of risk factors participate in less stressful aerobic activity to maintain the benefits of physical activity without incurring increased risk for early OA and subsequent disability.

Baumgarten, B. (2007). To Run or Not To Run: A Post-Menisectomy Qualitative Risk Model for Osteoarthritis when Considering a Return to Recreational Running.. Journal of Manual & Manipulative Therapy, 15(1), E1-E15.

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