A randomised controlled trial of meniscal surgery compared with exercise and patient education for treatment of meniscal tears in young adults

Introduction Arthroscopic surgery is a very common
orthopaedic procedure. While several trials have
investigated the effect of knee arthroscopy for middleaged and older patients with meniscal tears, there is a
paucity of trials comparing meniscal surgery with nonsurgical treatment for younger adults. The aim of this
randomised controlled trial (RCT) is to investigate if early
arthroscopic surgery is superior to exercise therapy and
education, with the option of later surgery if needed, in
improving pain, function and quality of life in younger
adults with meniscal tears.
Methods and analysis This is a protocol for a multicentre,
parallel-group RCT conducted at six hospitals across all five
healthcare regions in Denmark. 140 patients aged 18–40
years with a clinical history and symptoms consistent with
a meniscal tear, verified on MRI, found eligible for meniscal
surgery by an orthopaedic surgeon will be randomly allocated
to one of two groups (1:1 ratio). Participants randomised
to surgery will undergo either arthroscopic partial
meniscectomy or meniscal repair followed by standard
postsurgical care, while participants allocated to exercise and
education will undergo a 12-week individualised, supervised
neuromuscular and strengthening exercise programme and
patient education. The primary outcome will be difference
in change from baseline to 12 months in the mean score on
four Knee Injury and Osteoarthritis Outcome Score subscales,
covering pain, symptoms, function in sports and recreation
and quality of life (Knee Injury and Osteoarthritis Outcome
Score (KOOS4
)) supported by the individual subscale scores
allowing clinical interpretation. Alongside, the RCT an
observational cohort will follow patients aged 18–40 years
with clinical suspicion of a meniscal tear, but not fully eligible
or declining to participate in the trial.