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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.


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).

SUBMITTER: Noorduyn JCA 

PROVIDER: S-EPMC7607803 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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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.

Noorduyn Julia C A JCA   Glastra van Loon Tess T   van de Graaf Victor A VA   Willigenburg Nienke W NW   Butter Ise K IK   Scholten-Peeters Gwendolyne G M GGM   Coppieters Michel W MW   Poolman Rudolf W RW   Scholtes Vanessa A B VAB   Mutsaerts Eduard L A R ELAR   Krijnen Matthijs R MR   Moojen Dirk Jan F DJF   van Deurzen Derek F P DFP   Bloembergen Coen H CH   Wolkenfelt Julius J   de Gast Arthur A   Snijders Thom T   Saris Daniel B F DBF   Wolterbeek Nienke N   Neeter Camille C   Kerkhoffs Gino M M J GMMJ   Peters Rolf W RW   van den Brand Igor C J B ICJB   de Vos-Jakobs Suzanne S   Spoor Andy B AB   Gosens Taco T   Rezaie Wahid W   Hofstee Dirk Jan DJ   Burger Bart J BJ   Haverkamp Daniel D   Vervest Anton M J S AMJS   van Rheenen Thijs A TA   Wijsbek Anne E AE   van Arkel Ewoud R A ERA   Thomassen Bregje J W BJW   Sprague Sheila S   van Tulder Maurits W MW   Schavemaker Mirjam M   van Dijk Rogier R   van der Kraan J J  

Orthopaedic journal of sports medicine 20201029 10


<h4>Background</h4>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.<h4>Purpose</h4>To compare partial meniscectomy with physical therapy in patients with a degenerative meniscal tear, focusing on patients' most important functional limitations as the outcome.<h4>Study design</h4>Randomized controlled trial; Level of evidence, 1.<h4>Methods</h4>This study is part of  ...[more]

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