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Effect of exercise therapy versus surgery on mechanical symptoms in young patients with a meniscal tear: a secondary analysis of the DREAM trial
  1. Camma Damsted1,2,
  2. Jonas Bloch Thorlund1,3,
  3. Per Hölmich4,
  4. Martin Lind5,
  5. Claus Varnum6,
  6. Martin Dalgaard Villumsen7,
  7. Mogens Strange Hansen8,
  8. Søren T Skou1,2
  1. 1Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  2. 2The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
  3. 3Research Unit for General Practice, Department of Public Health, University of Southern, Denmark, Odense, Denmark
  4. 4Department of Orthopedic Surgery, Sports Orthopaedic Research Center–Copenhagen (SORC-C), Arthroscopic Center, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
  5. 5Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
  6. 6Department of Orthopaedic Surgery, Lillebælt Hospital Vejle, Vejle, Denmark
  7. 7Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  8. 8Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
  1. Correspondence to Dr Camma Damsted, Faculty of Health Sciences, University of Southern Denmark, Odense 5230, Denmark; cdamsted{at}health.sdu.dk

Abstract

Objective To compare the effect of early surgery versus exercise and education on mechanical symptoms and other patient-reported outcomes in patients aged 18–40 years with a meniscal tear and self-reported mechanical knee symptoms.

Methods In a randomised controlled trial, 121 patients aged 18–40 years with a MRI-verified meniscal tear were randomised to surgery or 12-week supervised exercise and education. For this study, 63 patients (33 and 30 patients in the surgery and in the exercise group, respectively) reporting baseline mechanical symptoms were included. The main outcome was self-reported mechanical symptoms (yes/no) at 3, 6 and 12 months assessed using a single item from the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes were KOOS4 and the 5 KOOS-subscales and the Western Ontario Meniscal Evaluation Tool (WOMET).

Results In total, 55/63 patients completed the 12-month follow-up. At 12 months, 9/26 (35%) in the surgery group and 20/29 (69%) in the exercise group reported mechanical symptoms. The risk difference and relative risk at any time point was 28.7% (95% CI 8.6% to 48.8%) and 1.83 (95% CI 0.98 to 2.70) of reporting mechanical symptoms in the exercise group compared with the surgery group. We did not detect any between-group differences in the secondary outcomes.

Conclusion The results from this secondary analysis suggest that early surgery is more effective than exercise and education for relieving self-reported mechanical knee symptoms, but not for improving pain, function and quality of life in young patients with a meniscal tear and mechanical symptoms.

Trial registration number NCT02995551.

  • exercise therapy
  • knee injuries
  • rehabilitation
  • sports medicine
  • orthopedics

Data availability statement

Data are available on reasonable request.

http://dx.doi.org/10.1136/bjsports-2022-106207

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Twitter @CammaDamsted, @jbthorlund, @martinvillumsen, @STSkou

    • Contributors STS and JBT conceived the DREAM trial. The analysis plan for this study was developed by CD, STS and JBT, with critical feedback and input from PH, ML, CV, MSH and MDV. CD and MDV performed the statistical analyses and interpreted the data with input from STS and JBT. CD drafted the first version of the manuscript with assistance from STS and JBT. PH, ML, CV, MSH and MDV provided critical intellectual input to the manuscript and all authors approved the final version of the manuscript. CD acts as a guarantor for the ovelall content.

    • Funding Independent Research Fund Denmark and Sapere Aude Research Talent Award (DFF-6110-00045, DFF-6110-00045B), IMK Almene Fond, Lundbeck Foundation, Spar Nord Foundation, Danish Rheumatism Association, Association of Danish Physiotherapists Research Fund, Research Council at Næstved-Slagelse-Ringsted Hospitals and Region Zealand (Exercise First programme grant). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Outside the submitted study, STS is currently funded by two grants from the European Union’s Horizon 2020 research and innovation program, one from the European Research Council (MOBILIZE, grant agreement No 801790) and the other under grant agreement No 945377 (ESCAPE).

    • 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.