Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial

Abstract

ObjectiveTo compare outcomes from arthroscopic partial meniscectomy versus physical therapy in young patients with traumatic meniscal tears.MethodsWe conducted a multicentre, open-labelled, randomised controlled trial in patients aged 18–45 years, with a recent onset, traumatic, MRI-verified, isolated meniscal tear without knee osteoarthritis. Patients were randomised to arthroscopic partial meniscectomy or standardised physical therapy with an optional delayed arthroscopic partial meniscectomy after 3-month follow-up. The primary outcome was the International Knee Documentation Committee (IKDC) score (best 100, worst 0) at 24 months, which measures patients’ perception of symptoms, knee function and ability to participate in sports activities.ResultsBetween 2014 and 2018, 100 patients were included (mean age 35.1 (SD 8.1), 76% male, 34 competitive or elite athletes). Forty-nine were randomised to arthroscopic partial meniscectomy and 51 to physical therapy. In the physical therapy group, 21 patients (41%) received delayed arthroscopic partial meniscectomy during the follow-up period. In both groups, improvement in IKDC scores was clinically relevant during follow-up compared with baseline scores. At 24 months mean (95% CI) IKDC scores were 78 (71 to 84) out of 100 points in the arthroscopic partial meniscectomy group and 78 (71 to 84) in the physical therapy group with a between group difference of 0.1 (95% CI −7.6 to 7.7) points out of 100.ConclusionsIn this trial involving young patients with isolated traumatic meniscal tears, early arthroscopic partial meniscectomy was not superior to a strategy of physical therapy with optional delayed arthroscopic partial meniscectomy at 24-month follow-up.Trial registrationhttps://www.trialregister.nl/trials.

Evaluation and Treatment of Knee Pain

“…For longer-term outcomes, both surgical and nonsurgical treatments are effective. Two RCTs of 121 and 100 young adults (mean age, 30-35 years) compared early surgery (arthroscopic partial meniscectomy or meniscal repair) with 12 weeks of exercise therapy (neuromuscular exercises 1-2 times weekly) with the option of surgery later if needed. Both RCTs found that both groups experienced clinically relevant improvements in pain and function with no clinically important differences between groups .…”

“…Two RCTs of 121 and 100 young adults (mean age, 30-35 years) compared early surgery (arthroscopic partial meniscectomy or meniscal repair) with 12 weeks of exercise therapy (neuromuscular exercises 1-2 times weekly) with the option of surgery later if needed. Both RCTs found that both groups experienced clinically relevant improvements in pain and function with no clinically important differences between groups . In both RCTs, patients with severe displaced tears (ie, locked knee indicative of displaced bucket-handle tear) and those associated with an anterior cruciate ligament rupture were excluded, as these cases typically have more aggravating symptoms and require surgery.…”

“…Systematic reviews report that 80% to 87% of athletes return to preinjury sports competition following meniscal surgery and do so 7 to 9 weeks after partial meniscectomy and 5 to 6 months after meniscal repair . There was no difference in ability to participate in sports among patients receiving either type of management in 2 RCTs studying surgical and nonsurgical management . However, in the long term, meniscal tears increase the risk of incident OA.…”

Two-year MRI-defined structural damage and patient-reported outcomes following surgery or exercise for meniscal tears in young adults

“…Meniscal tears in young adults have typically been treated with arthroscopic surgery. Recently, two randomised trials comparing early meniscal surgery to exercise therapy and education with optional delayed surgery (if needed) reported clinically relevant improvements in patient-reported outcomes (PROMs) for both treatment strategies, with negligible between-group differences 1 2. Furthermore, in the two trials, many patients randomised to exercise (84% at 12 months and 59% at 24 months) did not undergo surgery during follow-up 1 2…”

Editor’s Spotlight/Take 5: Has Arthroscopic Meniscectomy Use Changed in Response to the Evidence? A Large-database Study From Spain

“…We cannot ignore the evidence: At this point, about a dozen welldesigned, randomized controlled trials confirm that fact [3,9,10,12,13,26,27,28,32], and I can find only one RCT [5]-a problematic study for reasons I've described before [14]that suggests anything different. Evidence from two recent randomized trials has even questioned its use among younger patients, excluding those who present with locking [29,31]. This puts the onus on those who think the operation helps to prove it.…”