Detailed Search Results
| Author/Association: | Damsted C, Thorlund JB, Holmich P, Lind M, Varnum C, Villumsen MD, Hansen MS, Skou ST |
| Title: | Effect of exercise therapy versus surgery on mechanical symptoms in young patients with a meniscal tear: a secondary analysis of the DREAM trial [with consumer summary] |
| Source: | British Journal of Sports Medicine 2023 May;57(9):521-527 |
| Method: | clinical trial |
| Method Score: | 4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
| Consumer Summary: | WHAT IS ALREADY KNOWN ON THIS TOPIC: Surgery is typically considered the best treatment to alleviate mechanical symptoms in young patients with a meniscal tear. However, there is no evidence for a better effect of meniscal surgery over non-surgical alternatives in alleviating mechanical symptoms. WHAT THIS STUDY ADDS: Surgery seemed more effective in alleviating patient-reported mechanical symptoms compared with a treatment strategy of exercise therapy and patient education in patients aged 40 years or younger. No relevant between-group treatment difference was observed for other patient-reported outcomes including pain, function and quality of life. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY: The findings of this study highlight the importance of including the patient's perception of their different symptoms as well as treatment preferences and needs when deciding an individual treatment strategy. |
| Abstract: | OBJECTIVE: To compare the effect of early surgery versus exercise and education on mechanical symptoms and other patient-reported outcomes in patients aged 18 to 40 years with a meniscal tear and self-reported mechanical knee symptoms. METHODS: In a randomised controlled trial, 121 patients aged 18 to 40 years with a MRI-verified meniscal tear were randomised to surgery or 12-week supervised exercise and education. For this study, 63 patients (33 and 30 patients in the surgery and in the exercise group, respectively) reporting baseline mechanical symptoms were included. The main outcome was self-reported mechanical symptoms (yes/no) at 3, 6 and 12 months assessed using a single item from the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes were KOOS4 and the 5 KOOS-subscales and the Western Ontario Meniscal Evaluation Tool (WOMET). RESULTS: In total, 55/63 patients completed the 12-month follow-up. At 12 months, 9/26 (35%) in the surgery group and 20/29 (69%) in the exercise group reported mechanical symptoms. The risk difference and relative risk at any time point was 28.7% (95% CI 8.6% to 48.8%) and 1.83 (95% CI 0.98 to 2.70) of reporting mechanical symptoms in the exercise group compared with the surgery group. We did not detect any between-group differences in the secondary outcomes. CONCLUSION: The results from this secondary analysis suggest that early surgery is more effective than exercise and education for relieving self-reported mechanical knee symptoms, but not for improving pain, function and quality of life in young patients with a meniscal tear and mechanical symptoms. TRIAL REGISTRATION NUMBER: NCT02995551. Reproduced with permission from the BMJ Publishing Group. Full text (sometimes free) may be available at these link(s):  help |
