OBJECTIVE: To examine five-year outcomes of treatment of meniscal tear in osteoarthritis. METHODS: We examined 5-year follow-up data from the MeTeOR (Meniscal Tear in Osteoarthritis Research) Trial of physical therapy (PT) versus arthroscopic partial meniscectomy (APM). We performed primary intention-to-treat (ITT) and secondary as-treated analyses. The primary outcome was the Knee Osteoarthritis and Injury Outcome Score (KOOS) Pain scale; total knee replacement (TKR) was a secondary outcome. We used piecewise linear mixed models to describe change in KOOS Pain. We calculated 5-year cumulative TKR incidence and used a Cox model to estimate hazard ratios (HR) for TKR. RESULTS: 351 participants were randomized. In the ITT analysis, KOOS Pain scores were approximately 46 (0 to 100, 100 worst) at baseline in both arms. Pain scores improved substantially in both arms over the first three months, continued to improve through 24 months (to approximately 18 in each arm) and were stable from 24 to 60 months. Results of the as-treated analyses of KOOS Pain were similar. Twenty-five participants (7.1% (95% CI 4.4% to 9.8%)) underwent TKR over five years. In the ITT model, the HR for TKR was 2.0 (95% CI 0.8 to 4.9) for subjects randomized to APM, compared to those randomized to PT. The as-treated HR for TKR was 4.9 (95% CI 1.1 to 20.9) for subjects ultimately treated with APM, compared to those treated nonoperatively. CONCLUSION: Pain improved considerably in both arms over 60 months. While ITT analysis revealed no statistically significant differences in TKR use, greater TKR utilization in those receiving APM merits further study.
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