Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

Abstract

Background: Arthroscopic meniscal surgery is a common orthopaedic procedure in middle-aged patients, but the efficacy of this procedure has been questioned. In this study, we followed up the only randomized controlled trial that has shown a 1-year benefit from knee arthroscopic surgery with an exercise program compared with an exercise program alone.

Purpose: To (1) evaluate whether knee arthroscopic surgery combined with an exercise program provided an additional 5-year benefit compared with an exercise program alone in middle-aged patients with meniscal symptoms, (2) determine whether baseline mechanical symptoms affected the outcome, and (3) compare radiographic changes between treatment groups.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to either a 3-month exercise program (nonsurgery group) or to the same exercise program plus knee arthroscopic surgery (surgery group) within 4 weeks. Radiographs were assessed, according to the Kellgren-Lawrence grade, at baseline and at the 5-year follow-up. The primary outcome was the change in Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain (KOOS_PAIN) subscore from baseline to the 5-year follow-up. We performed an as-treated analysis.

Results: A total of 102 patients completed the 5-year questionnaire. At the 5-year follow-up, both groups had significant improvement in KOOS_PAIN subscores, although there was no significant change from the 3-year scores. There was no between-group difference in the change in the KOOS_PAIN subscore from baseline to 5 years (3.2 points [95% CI, -6.1 to 12.4]; adjusted P = .403). In the surgery group, improvement was greater in patients without mechanical symptoms than in those with mechanical symptoms (mean difference, 18.4 points [95% CI, 8.7 to 28.1]; P < .001). Radiographic deterioration occurred in 60% of patients in the surgery group and 37% of those in the nonsurgery group (P = .060).

Conclusion: Knee arthroscopic surgery combined with an exercise program provided no additional long-term benefit after 5 years compared with the exercise program alone in middle-aged patients with meniscal symptoms. Surgical outcomes were better in patients without mechanical symptoms than in patients with mechanical symptoms during the preoperative period. Radiographic changes did not differ between treatment groups.

Registration: NCT01288768 (ClinicalTrials.gov identifier).

Keywords: knee arthroscopic surgery; meniscectomy; menisci; middle-aged; radiographic osteoarthritis.

Figure 1.

Patient enrollment and randomization. Exclusion criteria were locked knee or joint locking for more than 2 seconds more often than once a week, rheumatic or neurological disease, fibromyalgia, replacement of hip or knee joints, or a contraindication for surgery (body mass index >35 kg/m² or a serious medical illness). Groups analyzed in the as-treated analysis: surgery group = a + c (total of 85 patients) and nonsurgery group = b + d (total of 61 patients).

Figure 2.

Mean Knee injury and Osteoarthritis Outcome Score (KOOS)–Pain subscore at baseline, 1 year, 3 years, and 5 years according to treatment group.

Figure 3.

Percentage of patients in each treatment group who showed the indicated change in the Knee injury and Osteoarthritis Outcome Score (KOOS)–Pain subscore from baseline to 5 years. Dotted horizontal lines indicate a 10-point change from baseline.