Functional Outcomes of Arthroscopic Partial Meniscectomy Versus Physical Therapy for Degenerative Meniscal Tears Using a Patient-Specific Score: A Randomized Controlled Trial
Authors: Noorduyn Julia C.A. , Glastra van Loon Tess , van de Graaf Victor A. , Willigenburg Nienke W. , Butter Ise K. , Scholten-Peeters Gwendolyne G.M. , Coppieters Michel W. , Poolman Rudolf W. ,   the ESCAPE Research Group, Scholtes Vanessa A.B. , Mutsaerts Eduard L.A.R. , Krijnen Matthijs R. , Moojen Dirk Jan F. , van Deurzen Derek F.P. , Bloembergen Coen H. , Wolkenfelt Julius , de Gast Arthur , Snijders Thom , Saris Daniel B.F. , Wolterbeek Nienke , Neeter Camille , Kerkhoffs Gino M.M.J. , Peters Rolf W. , van den Brand Igor C.J.B. , de Vos-Jakobs Suzanne , Spoor Andy B. , Gosens Taco , Rezaie Wahid , Hofstee Dirk Jan , Burger Bart J. , Haverkamp Daniel , Vervest Anton M.J.S. , van Rheenen Thijs A. , Wijsbek Anne E. , van Arkel Ewoud R.A. , Thomassen Bregje J.W. , Sprague Sheila , van Tulder Maurits W. , Schavemaker Mirjam , van Dijk Rogier , van der Kraan J. 
Published: October 2020

Background:

It is unknown whether the treatment effects of partial meniscectomy and physical therapy differ when focusing on activities most valued by patients with degenerative meniscal tears.

Purpose:

To compare partial meniscectomy with physical therapy in patients with a degenerative meniscal tear, focusing on patients’ most important functional limitations as the outcome.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

This study is part of the Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE) trial, a multicenter noninferiority randomized controlled trial conducted in 9 orthopaedic hospital departments in the Netherlands. The ESCAPE trial included 321 patients aged between 45 and 70 years with a symptomatic, magnetic resonance imaging–confirmed meniscal tear. Exclusion criteria were severe osteoarthritis, body mass index >35 kg/m2, locking of the knee, and prior knee surgery or knee instability due to an anterior or posterior cruciate ligament rupture. This study compared partial meniscectomy with physical therapy consisting of a supervised incremental exercise protocol of 16 sessions over 8 weeks. The main outcome measure was the Dutch-language equivalent of the Patient-Specific Functional Scale (PSFS), a secondary outcome measure of the ESCAPE trial. We used crude and adjusted linear mixed-model analyses to reveal the between-group differences over 24 months. We calculated the minimal important change for the PSFS using an anchor-based method.

Results:

After 24 months, 286 patients completed the follow-up. The partial meniscectomy group (n = 139) improved on the PSFS by a mean of 4.8 ± 2.6 points (from 6.8 ± 1.9 to 2.0 ± 2.2), and the physical therapy group (n = 147) improved by a mean of 4.0 ± 3.1 points (from 6.7 ± 2.0 to 2.7 ± 2.5). The crude overall between-group difference showed a –0.6-point difference (95% CI, –1.0 to –0.2; P = .004) in favor of the partial meniscectomy group. This improvement was statistically significant but not clinically meaningful, as the calculated minimal important change was 2.5 points on an 11-point scale.

Conclusion:

Both interventions were associated with a clinically meaningful improvement regarding patients’ most important functional limitations. Although partial meniscectomy was associated with a statistically larger improvement at some follow-up time points, the difference compared with physical therapy was small and clinically not meaningful at any follow-up time point.

Registration:

NCT01850719 ( ClinicalTrials.gov identifier) and NTR3908 (the Netherlands Trial Register).