Early surgery versus exercise therapy and patient education for traumatic and non-traumatic meniscal tears in young adults - an exploratory analysis from the DREAM-trial

Camma Damsted*, Søren T Skou, Per Hölmich, Martin Lind, Claus Varnum, Hans Peter Jensen, Mogens Strange Hansen, Jonas Bloch Thorlund

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVE: To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. DESIGN: Randomized controlled trial. METHODS: In a randomized controlled trial (the "Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults" [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging-verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS4) covering pain, symptoms, function in sport and recreation, and quality of life. RESULTS: Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS4 after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). CONCLUSION: In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 22 February 2024. doi:10.2519/jospt.2024.12245.

Original languageEnglish
JournalThe Journal of orthopaedic and sports physical therapy
Volume54
Issue number5
Pages (from-to)340-349
ISSN0190-6011
DOIs
Publication statusPublished - May 2024

Keywords

  • knee
  • meniscal tears
  • symptom onset
  • traumatic
  • treatment
  • Time-to-Treatment
  • Humans
  • Male
  • Tibial Meniscus Injuries/therapy
  • Young Adult
  • Arthroscopy
  • Meniscectomy
  • Adolescent
  • Quality of Life
  • Adult
  • Female
  • Exercise Therapy/methods
  • Patient Education as Topic

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