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. 2020 Oct 29;8(10):2325967120954392.
doi: 10.1177/2325967120954392. eCollection 2020 Oct.

Functional Outcomes of Arthroscopic Partial Meniscectomy Versus Physical Therapy for Degenerative Meniscal Tears Using a Patient-Specific Score: A Randomized Controlled Trial

Julia C A Noorduyn  1 , Tess Glastra van Loon  1 , Victor A van de Graaf  1 , Nienke W Willigenburg  1 , Ise K Butter  1 , Gwendolyne G M Scholten-Peeters  2 , Michel W Coppieters  2   3 , Rudolf W Poolman  1   4 ; ESCAPE Research Group; Vanessa A B Scholtes  1   2   3   4   5 , Eduard L A R Mutsaerts  1   2   3   4   5 , Matthijs R Krijnen  1   2   3   4   5 , Dirk Jan F Moojen  1   2   3   4   5 , Derek F P van Deurzen  1   2   3   4   5 , Coen H Bloembergen  1   2   3   4   5 , Julius Wolkenfelt  1   2   3   4   5 , Arthur de Gast  1   2   3   4   5 , Thom Snijders  1   2   3   4   5 , Daniel B F Saris  1   2   3   4   5 , Nienke Wolterbeek  1   2   3   4   5 , Camille Neeter  1   2   3   4   5 , Gino M M J Kerkhoffs  1   2   3   4   5 , Rolf W Peters  1   2   3   4   5 , Igor C J B van den Brand  1   2   3   4   5 , Suzanne de Vos-Jakobs  1   2   3   4   5 , Andy B Spoor  1   2   3   4   5 , Taco Gosens  1   2   3   4   5 , Wahid Rezaie  1   2   3   4   5 , Dirk Jan Hofstee  1   2   3   4   5 , Bart J Burger  1   2   3   4   5 , Daniel Haverkamp  1   2   3   4   5 , Anton M J S Vervest  1   2   3   4   5 , Thijs A van Rheenen  1   2   3   4   5 , Anne E Wijsbek  1   2   3   4   5 , Ewoud R A van Arkel  1   2   3   4   5 , Bregje J W Thomassen  1   2   3   4   5 , Sheila Sprague  1   2   3   4   5 , Maurits W van Tulder  1   2   3   4   5 , Mirjam Schavemaker  1   2   3   4   5 , Rogier van Dijk  1   2   3   4   5 , J van der Kraan  1   2   3   4   5
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Functional Outcomes of Arthroscopic Partial Meniscectomy Versus Physical Therapy for Degenerative Meniscal Tears Using a Patient-Specific Score: A Randomized Controlled Trial

Julia C A Noorduyn et al. Orthop J Sports Med. .

Abstract

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).

Keywords: Knee; Patient-Specific Functional Scale; arthroscopic surgery; meniscus; physical therapy.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Funding for the ESCAPE trial was provided by the Netherlands Organization for Health Research and Development (ZonMw; grant 837002009), Zilveren Kruis (grant Z436), and the foundation of medical research of OLVG (grant 15u.025). The funders had no role in designing and conducting this study; the collection, management, analysis, and interpretation of the data; the preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flow of patients. The flowchart shows the follow-up data of all patients allocated to a treatment group. The number of missing patients refers to the patients who were missing for a specific follow-up time point. These patients continued participating in the remaining follow-up time points. Patients who dropped out from the trial were referred to as “loss to follow-up.” Data of patients screened for eligibility were not available.
Figure 2.
Figure 2.
Mean Patient-Specific Functional Scale (PSFS) scores for each group at baseline and at 3, 6, 12, and 24 months. The mean difficulty scores per group were calculated as the mean of the overall PSFS score per patient, adding the scores for each activity and dividing this by the number of selected activities per patient. Data in parentheses and error bars indicate the 95% CIs.
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