Journal Article

Effect of exercise therapy versus surgery on mechanical symptoms in young patients with a meniscal tear: a secondary analysis of the DREAM trial

Villumsen, Martin Dalgaard, Thorlund, Jonas Bloch, Lind, Martin, Varnum, Claus, Skou, Søren T, Damsted, Camma, Hölmich, Per, Hansen, Mogens Strange

2023

Overview

ObjectiveTo compare the effect of early surgery versus exercise and education on mechanical symptoms and other patient-reported outcomes in patients aged 18–40 years with a meniscal tear and self-reported mechanical knee symptoms.MethodsIn a randomised controlled trial, 121 patients aged 18–40 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).ResultsIn 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.ConclusionThe 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.

• Publisher: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine,BMJ Publishing Group LTD
• Subject: Arthritis / Arthroscopy - methods / Clinical outcomes / Exercise / exercise therapy / Exercise Therapy - methods / Humans / Knee / knee injuries / Knee Injuries - surgery / Middle age / Multiculturalism & pluralism / Original research / Orthopedics / Osteoarthritis / Osteoarthritis, Knee - surgery / Pain / Patient education / Physical therapy / Quality of Life / rehabilitation / Self report / sports medicine / Surgeons / Surgery / Tibial Meniscus Injuries - surgery