Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial

Abstract

To evaluate progression of individual radiographic features five years following exercise therapy or arthroscopic partial meniscectomy as treatment for degenerative meniscal tear. DesignRandomized controlled trial including 140 adults, aged 35-60 years, with a magnetic resonance image verified degenerative meniscal tear, and 96% without definite radiographic knee osteoarthritis. Participants were randomized to either 12-weeks of supervised exercise therapy or arthroscopic partial meniscectomy. The primary outcome was between-group difference in progression of tibiofemoral joint space narrowing and marginal osteophytes at five years, assessed semi-quantitatively by the OARSI atlas. Secondary outcomes included incidence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis, medial tibiofemoral fixed joint space width (quantitatively assessed), and patient-reported outcome measures. Statistical analyses were performed using a full analysis set. Per protocol and as treated analysis were also performed. ResultsThe risk ratios (95% CI) for progression of semi-quantitatively assessed joint space narrowing and medial and lateral osteophytes for the surgery group were 0.89 (0.55-1.44), 1.15 (0.79-1.68) and 0.77 (0.42-1.42), respectively, compared to the exercise therapy group. In secondary outcomes (full-set analysis) no statistically significant between-group differences were found. ConclusionThe study was inconclusive with respect to potential differences in progression of individual radiographic features after surgical and non-surgical treatment for degenerative meniscal tear. 6Further, we found no strong evidence in support of differences in development of incident radiographic knee osteoarthritis or patient-reported outcomes between exercise therapy and arthroscopic partial meniscectomy.Trial registration: www.clinicaltrials.gov (NCT01002794)

On a Trajectory for Success—9 in Every 10 People With a Degenerative Meniscus Tear Have Improved Knee Function Within 2 Years After Treatment: A Secondary Exploratory Analysis of a Randomized Controlled Trial

“…We pooled data from both treatment groups to improve precision and statistical power, which means that we had a heterogeneous sample with respect to treatment. Even though no between-group differences have been detected for changes in patient-reported outcomes in the OMEX trial 5,20 or in several other high-quality randomized controlled trials, 13,39,44 we cannot discount the possibility that trajectories and associated prognostic factors differ between the 2 treatments.…”

Response to Letter to the Editor: “Osteoarthritis progression after exercise therapy or meniscectomy in patients with degenerative meniscal tears”

“…We thank Yu et al for their interest in our recent publication entitled "Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial" 1 .…”

“…We certainly agree with the authors that MRI findings are no cause for treatment, surgical or non-surgical. As described in the inclusion criteria, all patients had to be considered eligible for surgery 1 . We would like to clarify that one experienced orthopedic surgeon at Oslo University Hospital or one experienced orthopedic surgeon at Martina Hansens Hospital confirmed eligibility based on patient history, physical examination, and MRI findings 2 .…”

Treatment of post-meniscectomy knee symptoms with medial meniscus replacement results in greater pain reduction and functional improvement than non-surgical care

“…Evidence from randomized controlled trials (RCT) has suggested that partial meniscectomy may not be superior to non-surgical care alone or sham surgery, but some trials had important study design limitations and high cross-over rates [1,7,27,32,33,35,36]. Nonetheless, expert consensus statements and professional societies recommend partial meniscectomy for patients with irreparable meniscus tears and mechanical knee symptoms that are refractory to at least 3 months of non-surgical care [5,19].…”