Article Text

Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial
  1. Sabine J A van der Graaff1,
  2. Susanne M Eijgenraam1,
  3. Duncan E Meuffels1,
  4. Eline M van Es1,
  5. Jan A N Verhaar1,
  6. Dirk Jan Hofstee2,
  7. Kiem Gie Auw Yang3,
  8. Julia C A Noorduyn4,
  9. Ewoud R A van Arkel5,
  10. Igor C J B van den Brand6,
  11. Rob P A Janssen7,8,
  12. Wai-Yan Liu7,9,
  13. Sita M A Bierma-Zeinstra1,10,
  14. Max Reijman1
  1. 1 Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  2. 2 Orthopaedics, Noordwest Hospital Group, Alkmaar, The Netherlands
  3. 3 Orthopaedics, Sint Antonius Hospital, Nieuwegein, The Netherlands
  4. 4 Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
  5. 5 Orthopaedics, Haaglanden Medical Centre, Den Haag, The Netherlands
  6. 6 Orthopaedics, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
  7. 7 Orthopaedic Surgery, Maxima Medical Centre, Eindhoven, The Netherlands
  8. 8 Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
  9. 9 Orthopaedic Surgery, Catharina Hospital, Eindhoven, The Netherlands
  10. 10 Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Max Reijman, Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; m.reijman{at}erasmusmc.nl

Abstract

Objective To compare outcomes from arthroscopic partial meniscectomy versus physical therapy in young patients with traumatic meniscal tears.

Methods We 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.

Results Between 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.

Conclusions In 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.

  • Meniscus
  • Randomized Controlled Trial

Data availability statement

Data are available on reasonable request. Individual de-identified participant data that underlie the results reported in this paper (text, tables, figures and appendices) and the study protocol will be shared if requested. Data will be available beginning 12 months and ending 5 years following publication of this paper. Data will be available for researchers who provide a methodologically sound scientific proposal, which has been approved by an ethical committee. Proof of the latter should be provided. Analyses should achieve the aims as reported in the approved proposal. Proposals for data should be directed to m.reijman@erasmusmc.nl.

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Data availability statement

Data are available on reasonable request. Individual de-identified participant data that underlie the results reported in this paper (text, tables, figures and appendices) and the study protocol will be shared if requested. Data will be available beginning 12 months and ending 5 years following publication of this paper. Data will be available for researchers who provide a methodologically sound scientific proposal, which has been approved by an ethical committee. Proof of the latter should be provided. Analyses should achieve the aims as reported in the approved proposal. Proposals for data should be directed to m.reijman@erasmusmc.nl.

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Footnotes

  • SJAvdG and SME are joint first authors.

  • Contributors MR, SE and DEM conceived and designed the study. All authors acquired, analysed or interpreted the data. SJAvdG and MR performed the statistical analysis. SJAvdG, SE, MR and DEM drafted the manuscript. All authors critically revised the manuscript for important intellectual content. MR and DEM are the guarantors.

  • Funding The authors received a grant for this study from ZonMw, a Dutch organization for health research and care innovation.

  • Disclaimer The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.