Please select the eligibility criteria that correspond to the clinical trial below.
Title: Danish Rct on Exercise Versus Arthroscopic Meniscal Surgery for Young Adults (DREAM) - A Randomized Controlled Trial of Meniscal Tear Treatment in Young Adults
Brief Summary: There are two cartilage structures in each knee joint called a meniscus. A torn meniscus can be caused by either a smaller or larger trauma or be a degenerative age-related tear. Arthroscopic meniscal surgery is the most common orthopedic procedure, but no high-quality studies have investigated the efficacy of meniscal surgery for younger patients (i.e. 40 years or younger) in comparison to non-surgical treatments.

The purpose of this study is to determine if a strategy of early arthroscopic meniscal surgery (repair or resection) is superior to a strategy of initial individualized supervised exercise therapy including patient education with the option of later surgery if needed in improving pain, function and quality of life in young patients (18-40 years) with meniscal tears.

The hypothesis is that patients treated with early arthroscopic meniscal surgery will improve more than patients treated with exercise and education.


Options:
A: Inclusion Criteria:

1. Age: 35 to 65 years of age.
2. A pain located on the medial joint line of the knee that has persistent at least for 3 months.
3. Pain that can be provoked by palpation or compression of the joint line or a positive McMurray sign.
4. Tear of the medial meniscus on MRI.
5. Degenerative rupture of the medial meniscus confirmed at arthroscopy.

Exclusion Criteria:

1. Acute, trauma-induced onset of symptoms.
2. Locking or painful snapping of the knee joint.
3. A surgical operation performed on the affected knee.
4. Osteoarthritis of the medial compartment of the knee (determined by clinical criteria of the ACR).
5. Osteoarthritis on knee radiographs (Kellgren-Lawrence \> 1).
6. Acute (within the previous year) fractures of the knee.
7. Decreased range of motion of the knee.
8. Instability of the knee.
9. MRI assessment showing a tumor or any other complaint requiring surgical or other means of treatment.
10. Arthroscopic assessment showing anything other than a degenerative tear of the medial meniscus requiring surgical intervention.
B: Inclusion Criteria:

* Adults aged 18 to 40 years with knee pain
* Clinical history and symptoms consistent with meniscal tear and meniscal tear verified on magnetic resonance imaging (MRI)
* Deemed eligible for meniscal surgery (i.e. repair or resection) by the examining orthopedic surgeon
* Willing to participate in 12 weeks of supervised exercise twice a week or undergo surgery for the meniscal tear as soon as possible

Exclusion Criteria:

* Previous knee surgery on the affected knee
* Clinical suspicion (acute locking of knee AND/OR extension deficit) of displaced bucket-handle tear confirmed by MRI
* Fracture of the affected extremity within the previous 12 months
* Complete rupture of one or more knee ligaments.
* Participation in supervised systematic exercise for knee problems within the last 3 months prior to recruitment
* Other reasons for exclusion (Unable to understand Danish, mentally unable to participate, etc.)
C: Inclusion Criteria:

1. Idiopathic or secondary osteoarthritis of the knee as diagnosed by Altman et al 2 classification tree -83 percent sensitivity, 93percent specificity
2. Grades 2 to 4 severity of OA by radiographic evaluation- modified Kellgren and Lawrence grading system
3. Age greater than 18.

Exclusion Criteria:

1. Inflammatory or post-infection arthritis of the knee
2. Previous arthroscopy for treatment of knee OA
3. Isolated medial compartment OA Grade 3-4 with greater than 5 degrees mechanical varus -ideal candidate for high tibial osteotomy
4. Isolated lateral compartment OA Grade III-IV with greater than 5 degrees mechanical valgus -ideal candidate for high tibial osteotomy or distal femoral osteotomy
5. Grade 4 OA in at least 2 compartments and over 60 years of age -ideal candidate for total knee arthroplasty
6. Cortico-steroid injection within the last three months.
7. Major neurological deficit
8. Major medical illness -life expectancy less than 2 years or with unacceptably high operative risk.
9. Pregnant
10. Unable to speak or read English
11. Psychiatric illness that limits informed consent
12. Unwilling to be followed for 2 years
D: Inclusion Criteria:

* All (consecutive) patients referred to the orthopaedic department in Linköping for a suspected meniscal injury
* Age:45-64 years old
* No gonarthrosis (Ahlbäck=0) on standing radiographs

Exclusion Criteria:

* Rheumatic disease
* Patellofemoral arthrosis
* Fibromyalgia
* A knee or hip replacement
* A neurologic disorder including stroke
* A contraindication for an operation
* Catching or locking for more than 2 seconds more than once a week
* A permanent extension deficit
* Patients who cannot understand instructions in Swedish

Answer: B