The randomization scheme was stratified by hospital and age (45-57 and 58-70 years). Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. The 16 physical therapy sessions were compensated for patients allocated to physical therapy because this therapy is not reimbursed by the basic Dutch health insurance. S. Sprague (Division of Orthopaedic Surgery, Department of Surgery, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada). BMJ. Good griefit hurt! Our finding of an overall improvement in patient-reported outcomes after APM is consistent with data from randomized trials of APM compared with nonoperative treatment. [10]A recent study of over 700,000 arthroscopic partial meniscectomy cases had an overall complication rate of 0.61%. For this process, we divided patients into 3 groups: (1) patients allocated to arthroscopic partial meniscectomy who underwent surgery, (2) patients allocated to physical therapy who completed 16 or more physical therapy sessions, and (3) patients allocated to physical therapy who underwent arthroscopic partial meniscectomy during the 5-year follow-up. AL, JK, Song DJ, Price We randomized patients to arthroscopic partial meniscectomy or exercise-based physical therapy using a computerized randomization schedule with a 1:1 ratio and varying block sizes up to a maximum of 6. [14]The rate of infection was 0.135% within the first 90 days post-operatively, which is similar to previous rates published in prior studies. , van de Graaf Sensitivity of standing radiographs to detect knee arthritis: a systematic review of Level I studies. et al; ESCAPE Research Group. The deepest layer consists of circumferential fibers that aid with resisting hoop stresses during axial loading through the knee. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. JCA, Teuwen Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. The meniscus is predominantly comprised of type 1 and type 2 collagen. Disclosure: One author (M.H.J.) 1 Removal of an entire meniscus may increase the risk of arthritis about 10 years later. We included and randomized a total of 321 patients (mean [SD] age, 58 [6.6] years; 161 women [50.2%], 160 men [49.8%]) to either surgery (n=159) or physical therapy (n=162). We unblinded the treatment allocation after we reached consensus on interpretation of the results. MD, Guermazi 2019 Aug;27(8):2460-7. The RCTs that reported their results on the progression of knee OA following meniscal treatment have limited power to draw conclusions that can influence clinical practice. B, Roos 20. Osteoarthritis Cartilage. Radiological assessment of osteo-arthrosis. The primary outcome was patient-reported knee function (International Knee Documentation Committee Subjective Knee Form (range, 0 [worst] to 100 [best]) during 5 years of follow-up based on the intention-to-treat principle, with a noninferiority threshold of 11 points. Epub 2008 Dec 3. Postoperative monitoring of patient recovery is an important aspect of successful outcomes following meniscectomy. 1. You may be trying to access this site from a secured browser on the server. Patients were administered follow-up questionnaires at 1 year postoperatively. The VR-12 Physical Component Score (PCS) emphasizes items about physical functioning and pain, and the VR-12 Mental Component Score (MCS) emphasizes items about mental health and social functioning. also concluded that acute or chronic onset of symptoms, sex, tear type, and activity level were not associated with worse outcomes; they found conflicting evidence with regard to age, chondral damage, BMI, and leg alignment9. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. The inner third is dubbed the white-white zone and is avascular. For demographic factors, subjects with lower BMI had more improvement for all outcomes, subjects with younger age had more improvement in KOOS-PS but not in other outcomes, and subjects with more education had more improvement in KOOS Pain but not in other outcomes. D. J. Hofstee, B. J. Burger, C. H. Bloembergen (Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands). Epub 2018 Oct 29. It is well known that after a partial meniscectomy, the incidence rate of knee osteoarthritis increases [ 1 ]. Wild goose chase - no predictable patient subgroups benefit from meniscal surgery: patient-reported outcomes of 641 patients 1 year after surgery. From baseline to 5 years, we found no statistically significant differences between the 2 treatment groups in pain, general physical health, and quality of life. 2012 May;40(5):1138-43. et al; ESCAPE Research Group. 15. A partial meniscectomy is a surgery to remove a portion of the meniscus, a crescent-shaped piece of cartilage in the knee. 2023 American Medical Association. Throughout the general population, 16% of women aged 50 to 59 years have degenerative meniscal lesions, while men between the . , Pihl Epub 2013 Mar 24. Interventions Furthermore, we found comparable rates of progression of radiographic and symptomatic OA between both treatments. et al. M. Teuwen (Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands). Physical therapy was not inferior to arthroscopic partial meniscectomy. MMH, van de Graaf Am J Sports Med. [1]Despite the commonplace of meniscal pathology, these tears do not always become symptomatic. The Medial and Lateral meniscal cartilages are gasket like cushions in the knee. Any loose bodies are noted. Classically the meniscus is divided into three zones in regards to vascular supply. However, we used validated measures for OA, radiographic findings were reported by a single radiologist, and we adhered to the study protocol. L. 2023 American Medical Association. Then the medial gutter is examined before passing the camera into the medial tibiofemoral compartment while applying a valgus force to the leg to diastase the joint. N, Bijlsma We specifically chose to distinguish between radiographic knee OA, looking only at the structural changes of cartilage tissue, and symptomatic knee OA, combining structural changes on radiographic images with the patient-reported symptoms. Epub 2017 May 18 [PubMed PMID: 28522452], Abram SGF, Hopewell S, Monk AP, Bayliss LE, Beard DJ, Price AJ. After . Furthermore, we checked for confounding effects within our primary outcomes, and our adjusted analyses are in line with our primary unadjusted results. et al. S, Rijk It remains one of the most commonly performed orthopedic surgeries. 10. All Rights Reserved. H, Gauffin Surgical removal of a meniscus in the knee has been performed since the second half of the nineteenth century [ 1 ], and for a long period during the next century the menisci were seen as a rather troublesome tissue. A more detailed description of the selection criteria is presented in the protocol.21. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. Mark the medial and lateral borders of the patellar tendon from the inferior patella to the tibial tuberosity. 24. Baseline patient questionnaires were administered on tablet computers on the day of the surgical procedure and included demographic characteristics (age, sex, years of education), general health data (height, weight, smoking status), and patient-reported outcome measures (Veterans RAND 12 [VR-12] and Knee injury and Osteoarthritis Outcome Score [KOOS] Pain subscale, Physical Function Short Form [KOOS-PS], and knee-related Quality of Life [KOOS QOL]). , Ruyssen-Witrand VA, Mokkink Outerbridge RE. 2022 Noorduyn JCA et al. RH, Chaisson For meniscectomy, the patient is positioned supine on the operating room table. Ms Kret reported receiving grants from OLVG Joint Research Dutch Arthritis Society (ReumaNederland), ZonMw, grants from OLVG Joint Research Zilverenkruis Health Insurance (Achmea), and grants from OLVG Joint Research Foundation of Medical Research of the OLVG, Amsterdam, during the conduct of the study. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. JAMA Netw Open. We calculated bootstrap-validated R2 values for each model. Jones D, Kazis L, Lee A, Rogers W, Skinner K, Cassar L, Wilson N, Hendricks A. 14. D. Haverkamp (Department of Orthopaedic Surgery, Xpert Orthopedie, Amsterdam, The Netherlands). JCA, van de Graaf Physical therapy was not inferior to arthroscopic partial meniscectomy. Lateral articular cartilage status, patellofemoral articular cartilage status, synovitis, and a medial meniscal tear were not significant predictors of improvement. 2011 Oct:32(30):7411-31. doi: 10.1016/j.biomaterials.2011.06.037. We, however, performed the analyses and interpreted the results based on data that were blinded for treatment allocation. Five-year outcome of operative and non-operative management of meniscal tear in persons greater than 45 years old. N Engl J Med. Once the surgeon is satisfied with the meniscal resection, the arthroscopic instruments are removed from the knee. The supra-patellar pouch is examined first. The groups had similar baseline characteristics. J, Spindler While these results are consistent, debate still exists on the progression of osteoarthritis (OA) after arthroscopic partial meniscectomy.17-19 The long-term trial results have reported conflicting data with respect to this outcome.12-16 The RCT conducted by Sihvonen et al15 found that arthroscopic partial meniscectomy is associated with a slightly increased risk of radiographic knee OA compared with exercise therapy. NW, 9. A systematic review of outcomes after APM in 4,250 patients and 32 studies, including both prospective and retrospective data, concluded that the following factors were associated with worse outcomes: presence of radiographic knee osteoarthritis on preoperative radiographs, symptom duration longer than 1 year, and resecting >50% of meniscal tissue or leaving a damaged meniscal rim. In this noninferiority randomized clinical trial, no significant or clinically relevant between-group difference in patient-reported knee function was noted on the International Knee Documentation Committee Subjective Knee Form at the 5-year follow-up. Long-term complications following partial meniscectomy include re-operation due to the development of osteoarthritis. AP, Bayliss Method Short Form 36 (SF-36) data on 216 patients were retrospectively analysed for the influence of the factors age, gender and degree of cartilage degeneration. We calculated a sum score by adding the scores of all items. Knee Surg Sports Traumatol Arthrosc. Hemarthrosis is another complication seen after meniscectomy. B. Spoor, T. Gosens (Department of Orthopaedic Surgery, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands). Epub 2017 Sep 2 [PubMed PMID: 28873348], Faucett SC, Geisler BP, Chahla J, Krych AJ, Kurzweil PR, Garner AM, Liu S, LaPrade RF, Pietzsch JB. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. , Sonesson Clinically driven candidate variables were selected to be tested for removal in the event of overfitting by the full model to ensure that clinically important and significant variables were kept while reasonably satisfying degree of freedom to event ratios. The development of a short measure of physical function for knee OA KOOS-Physical Function Shortform (KOOS-PS)an OARSI/OMERACT initiative. A spinal needle can be used to assist in localizing the initial portal placement. Clinical anatomy (New York, N.Y.). Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. may email you for journal alerts and information, but is committed L, Anract I. C. J. JBJS Open Access5(4):e19.00044, October-December 2020. Recovery and rehabilitation take a few weeks. 8. Liebensteiner et al. There is a paucity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears. The arthroscopic partial meniscectomy included a standardized intra-articular inspection of the knee joint, including assessment of the lateral and medial meniscus, the anterior cruciate ligament, the level of chondropathy, and a general classification of the level of cartilage degeneration. We performed a 5-year follow-up assessment of patients in the ESCAPE trial, a multicenter RCT comparing arthroscopic partial meniscectomy with exercise-based physical therapy.6,21 The primary end point of the ESCAPE trial was at 2 years. evaluated 130 knees in 123 subjects using multivariable analysis, and a radial tear of the midsegment and a flap tear were both predictors of successful outcome; other tear types, including horizontal, complex, root, and minor tears, were not10. 7. To determine the progression of knee OA between baseline and 5-year follow-up, we used the OARSI sum score (range, 0-18) of the 6 items. The squares indicate the between-group differences with 95% CIs. They are each crescent-shaped, with the medial meniscus being more C shaped and the lateral meniscus U shaped. Data is temporarily unavailable. Data Sharing Statement: See Supplement 3. Higher VR-12 MCS at baseline predicted more improvement for all outcome measures except KOOS QOL. CHM. GE. This study has limitations. Such studies might provide insight into why so many patients opt for delayed arthroscopic partial meniscectomy following physical therapy and identify deimplementation strategies that could be tested. The secondary outcome was progression in knee osteoarthritis shown on radiographic images in both treatment groups. The costs of the physical therapy sessions were covered by Achmea Healthcare Foundation grant Z436. 12. For intra-articular findings, bipolar grade-3 or 4 medial compartment cartilage lesions predicted less improvement for all outcome measures, a lateral meniscal tear predicted less improvement for VR-12 PCS but not for other outcomes, and a prior surgical procedure on the index knee predicted less improvement for KOOS Pain but not for other outcomes. Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK. doi: 10.1016/j.otsr.2017.08.003. A limitation of our study was that we did not collect certain baseline factors hypothesized to have an effect on outcome. Group Information: The ESCAPE Research Group Collaborators: V. A. Figure 1 presents the patient flow through the trial, and Table 1 reports the baseline characteristics for the surgery and physical therapy groups. M, Candela From February 2015 until July 2016, 665 patients were enrolled, and 486 patients (73%) completed questionnaires at the 1-year follow-up. Arthroscopy. calculated the annual rate to be approximately 2% overall, but the rate increased to 3.9% in patients >50 years of age and 4.1% in patients with worse osteoarthritis at the time of the surgical procedure. There were clinically important and significant improvements (p < 0.001) in all patient-reported outcomes from baseline to the 1-year follow-up. We defined radiographic knee OA if at least 1 of the following criteria was met: (1) joint space narrowing grade 2 or higher, (2) sum of osteophyte grades greater than or equal to 2, or (3) grade 1 joint space narrowing in combination with 1 or more grade 1 osteophytes.12. , Sihvonen Customize your JAMA Network experience by selecting one or more topics from the list below. 2014 Nov;22(11):1808-16. et al. The surgery usually takes place under general anesthesia. Eijgenraam SM, Reijman M, Bierma-Zeinstra SMA, van Yperen DT, Meuffels DE. 2019 Mar:47(3):762-769. doi: 10.1177/0363546518755754. Arch Orthop Trauma Surg. Adjusted intervention effects were calculated using similar models expanded with the following potential confounders as independent variables6: level of OA at baseline using the KL classification,25 baseline pain during weight bearing, body mass index at baseline (<25, 25-30, or >30-35), and sex. Surgical treatment included arthroscopy with debridement of an unstable meniscus and articular cartilage tissue. Effect of early surgery vs physical therapy on knee function among patients with non-obstructive meniscal tears: the ESCAPE randomized clinical trial. 2020 Jun:54(11):652-663. doi: 10.1136/bjsports-2018-100223. Nearly 1 million knee arthroscopic procedures are performed in the United States each year, and arthroscopic partial meniscectomy (APM) is the most common1. A, Magnusson et al; ESCAPE Research Group. Concept and design: Noorduyn, van de Graaf, Willigenburg, Hawker, Coppieters, Poolman. The Journal of Bone and Joint Surgery, Inc. Multivariable statistical models were built to predict the improvement score in KOOS Pain, KOOS QOL, KOOS-PS, and VR-12. In addition, they commonly have intermittent effusions with or without pain. S, Ranstam In a systematic review that evaluated 20 articles for the annual risk of undergoing total knee arthroplasty after APM, Winter et al. To compare the 5-year effectiveness of arthroscopic partial meniscectomy and exercise-based physical therapy on patient-reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscal tear. You have two of them in each knee:. blinded to treatment allocation performed all radiographic evaluations to assess the presence and grade of knee OA using the KL scale, ranging from 0 (no knee OA) to 4 (severe knee OA),25 as well as the Osteoarthritis Research Society International (OARSI) atlas sum score,26 a semiquantitative instrument that assesses the severity of joint space narrowing and osteophytes in knee OA. We hypothesized that exercise-based physical therapy is noninferior to arthroscopic partial meniscectomy over a period of 5 years. 2011 Jan;39(1):99-107. Crude and Adjusted Between-Group Differences in Effect for Knee Function Overall and at Each Time Point, Gauffin According to the guidelines of the Dutch Orthopedic Association, we referred patients for physical therapy only in case of delayed recovery.10. combined the KL score, assessed by the radiologist, and the patient-reported KOOS-PS score into a symptomatic knee OA (yes or no) score using syntax coded in SPSS (IBM SPSS). , Katz Meniscectomy is a common orthopedic procedure done to alleviate knee pain in the older population with meniscal pathology. Subjects with a 10-point improvement in KOOS Pain or KOOS-PS were considered to have a successful treatment. EM, Englund MA, Tjomsland [2]Their primary function is load transmission across the tibiofemoral joint by converting compressive forces to horizontal hoop stress. Procedure Details et al. 4. WD Once the diagnostic arthroscopy is complete, the camera is taken back to the medial compartment. Atlas of individual radiographic features in osteoarthritis, revised. K, Levesque Fourth, we did not register noninvasive additional treatments for knee pain. We found a progression of at least 1 point on the OARSI sum score in 52% (n=42) of the physical therapy group, 54% (n=61) of the surgery group, and 70% (n=21) of the delayed-surgery group. Biomaterials. H, Tagesson The meniscus is intact in this arthroscopic image. 2015 Sep;135(9):1265-76. 2009 Feb;18(1):43-52. J, Yakob Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management. R, Kopf Arthroscopic partial meniscectomy or conservative treatment for nonobstructive meniscal tears: a systematic review and meta-analysis of randomized controlled trials. 2008 May;16(5):551-9. To test for robustness of the results regarding knee function and radiographic knee OA, we also performed an as-treated analysis. A 3-0 nylon suture is used to close the two portal sites, which are then dressed appropriately. T, A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM. Epub 2016 Jul 27. Understanding the predictors of failure to relieve pain or improve function and of worse outcome is important to provide patients and clinicians with the best evidence available to guide shared decision-making on treatment. Meniscus surgery is still widely performed in the treatment of degenerative meniscus tears in the Netherlands. MA, Stensrud DJ, Price Herrlin SV, Wange PO, Lapidus G, Hllander M, Werner S, Weidenhielm L. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? M, Malmivaara The menisci are essential shock absorbers for the joint. Meniscus pathology, osteoarthritis and the treatment controversy. Additionally, a diluted concentration of sterile normal saline with epinephrine can be injected intra-articularly to assist with limiting bleeding during the arthroscopy. Typically an athlete or active individual tears a meniscus with a twisting injury. VA, Scholtes The ChAMP randomized controlled trial. Epub 2008 Mar 4. Third, radiographic sensitivity for change in knee OA is lower compared with the sensitivity of magnetic resonance imaging, and therefore magnetic resonance imaging would be preferred over radiographic images.38 To minimize the patient burden and study costs, we obtained radiographic images instead of magnetic resonance imaging. We therefore introduced a pragmatic definition based on radiographic images and the Patient Acceptable Symptom State of the Knee Osteoarthritis Outcome Score-Physical Functioning Short-Form (KOOS-PS) score (range, 0 [best] to 100 [worst] physical functioning). 2. However, one-third of patients initially treated non-operatively failed conservative management and converted to surgery with improved results. We found no significant difference (P=.16) between the 3 groups in progression of the OARSI sum score from baseline to 5 years. J, Engebretsen The IKDC score for knee function per time point, shown with the box representing the IQR and median score indicated as the line within the box. , Crawford 2007 Nov:15(11):647-53 [PubMed PMID: 17989415], Sihvonen R, Paavola M, Malmivaara A, Itl A, Joukainen A, Nurmi H, Kalske J, Ikonen A, Jrvel T, Jrvinen TAH, Kanto K, Karhunen J, Knifsund J, Krger H, Kriinen T, Lehtinen J, Nyrhinen J, Paloneva J, Pivniemi O, Raivio M, Sahlman J, Sarvilinna R, Tukiainen S, Vlimki VV, rimaa V, Toivonen P, Jrvinen TLN, FIDELITY (Finnish Degenerative Meniscal Lesion Study) Investigators. Methods This randomized controlled study included 30 middle-aged (35-50), physically active patients who were randomized into LBE (n = 15) and AE (n = 15) groups . Patients completed self-administered questionnaires at baseline and 3 months, 6 months, 1 year, 2 years, and 5 years after enrollment. Purpose The purpose of this study is to investigate whether inconsistently reported factors influence the health-related quality of life (HRQOL) outcome of partial meniscectomy. S, Kvist Meniscus Form and Function. All covariates described above were specified a priori to be included in the full models for each outcome to enable adequate adjustment for clinically relevant confounders. JI, Aune S. R, Paavola Findings from this trial further support the recommendation that exercise-based physical therapy should be the preferred treatment over surgery for degenerative meniscal tears. The odds of successful treatment were lower in patients with a medial meniscal root tear, a lateral meniscal tear, or a higher baseline KOOS Pain score. We demonstrated, in a prospective cohort study of 486 patients undergoing APM, after adjusting for potential confounding factors, that patients with an isolated medial meniscal tear without damage to the medial meniscal root or to the lateral meniscus had greater odds of clinically important improvement at the 1-year follow-up compared with other patients. N, We hypothesized that cartilage damage and meniscal root tears would be associated with failure to relieve pain or improve function along with worse outcomes in these patients. The published protocol and 2-year results6,21 contain a detailed description of the design and methods of the trial, including the sample size calculation, and the study protocol is presented in Supplement 1. , Longo Achieving satisfactory outcomes following meniscectomy can be accomplished with an interprofessional team approach. The meniscus contributes to both load distribution and stability of the knee joint. RD, Gold [8], Ideally, partial meniscectomy is saved for patients who have persistent pain and/or mechanical symptoms after a trial of non-operative management. Knee Surg Sports Traumatol Arthrosc. A positive between-group value indicates greater mean improvement on the IKDC questionnaire in the surgery group compared with the physical therapy group. In these circumstances, the torn portion of the meniscus is resected with an attempt to try to preserve and sculpt as much of the remaining meniscus to both try and leave as much shock-absorbing capacity as possible, but also to try to minimize the chance of a re-tear. [16]This highlights the significance of the meniscus in regards to knee biomechanics and protecting the cartilage. The majority of meniscectomy procedures are done in an outpatient setting, so this role includes the management of intravenous fluids, administering pain medication, assisting with ambulation, and instruction on the use of assistive devices (such as crutches). Epub 2015 Jul 5. D, Crema A, Fernandez-Lopez In patients undergoing partial meniscectomy with degenerative meniscal tears, studies have shown the average delay to re-operation for total knee arthroplasty to be roughly 9 months. et al. 2005 Nov;33(11):1654-7. 2016 Jul 20;354:i3740. , Siemieniuk After general anesthesia induction, the patients leg is either positioned in the circumferential leg holder, or the lateral post is attached to the ipsilateral side of the operating table approximately 5 cm proximal to the superior pole of the patella. et al. Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial | Minimally Invasive Surgery | JAMA Network Open | JAMA Network Surgery versus physical therapy for a meniscal tear and osteoarthritis. Survivorship analysis and clinical outcomes of transtibial pullout repair for medial meniscus posterior root tears: a 5- to 10-year follow-up study. I merely kneeled down while talking to a neighbor and felt the unmistakable pain afterward. , Beaufils There is a paucity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears. Prognostic Level I. M. Privacy Policy| The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Throughout the procedure, care should be taken to minimize damage to the cartilage of the femur and tibia with the arthroscopic camera and instruments. Patients were excluded if they had undergone a bilateral surgical procedure. Study data were collected and managed using REDCap electronic data capture tools4. The two most commonly used portals for basic knee arthroscopy with partial meniscectomy will be inferomedial and inferolateral. CE, 1 The aim of the procedure is to relieve symptoms attributed to a meniscal tear by . Springer; 2015. Standard arthroscopic tower equipment, which includes: Basic arthroscopic instruments (including grasper, meniscal biter), Feel free to get in touch with us and send a message. SGF, Beard Meniscectomy is a commonly performed and effective treatment for the symptomatic meniscal tear. Published: July 8, 2022. doi:10.1001/jamanetworkopen.2022.20394. Additional patient-reported outcomes were (1) pain intensity during activities, assessed for the preceding week and scored using a visual analog scale ranging from 0 (no pain) to 100 (worst imaginable pain); (2) physical function using the KOOS-PS; and (3) quality of life, assessed with the EuroQol 5 Dimension 5 Level, which is a widely used instrument for health-related quality-of-life based on 5 dimensions: mobility, self-care, daily activities, pain/discomfort, and depression/anxiety.30 These 5 dimensions were combined into a health state. However, our pragmatic approach was chosen because the radiographic data were not part of our primary outcome. Importance VA, For the paper-based questionnaires, the researcher tried to retrieve missing items by telephone. In this noninferiority randomized clinical trial, no significant or clinically relevant between-group difference in patient-reported knee function was noted on the International Knee Documentation Committee Subjective Knee Form at the 5-year follow-up. Keywords: Knee; Mechanical symptoms, treatment Why is this study important? In conclusion, 83% of patients improved by at least 10 points in pain and function after APM. 13 Sources. Although we demonstrated that bipolar medial compartment cartilage lesions predicted worse outcomes, we did not measure whether articular cartilage lesions were stable or unstable23. M. Schavemaker (Department of Radiology, Dijklander Ziekenhuis, Hoorn, The Netherlands). The presence of osteoarthritic changes on radiographs has been shown to be insensitive to actual articular cartilage chondromalacia, so we believe that our arthroscopic assessment on each of the 6 surfaces is more important13. A controlled before-after study to evaluate the effect of a clinician led policy to reduce knee arthroscopy in NSW. However, the between-group differences are significantly smaller than the noninferiority threshold of 11 points, indicating that physical therapy is not inferior to arthroscopic partial meniscectomy. The eTable in Supplement 2 presents an overview of radiographic outcomes and patient-reported outcome measures at 5 years for the as-treated analysis. Supervision: van de Graaf, Willigenburg, Scholten-Peeters, Hawker, Coppieters, Poolman. Reaching the correct diagnosis and identifying patients who would benefit from meniscectomy is the first step towards successful outcomes. 2013 Feb;21(2):358-64. We assume that the COVID-19 pandemic would be one of the reasons why people did not attend the 5-year follow-up. Osteoarthritis Cartilage. Design, Setting, and Participants The tear pattern is identified. A meniscal biter instrument is then inserted into the inferomedial portal. Am J Sports Med. M, The between-group difference of 0.1 points (95% CI, 0.5 to 0.7; P=.78) was not significantly or clinically meaningful. The coefficients and p values for all outcomes and predictors are shown in Table III. , Yim , Abram 2017 Oct 4;18(1):408. Sixth, the number of patients screened for eligibility was not available. Epub 2011 Jul 18 [PubMed PMID: 21764438], Andrews SHJ, Adesida AB, Abusara Z, Shrive NG. We prospectively enrolled 665 patients who were 40 years of age and who had APM without any concomitant ligament or cartilage-resurfacing procedures. Epub 2008 Sep 30. The bootstrap-validated R2 values were 0.25 for VR-12 PCS, 0.26 for KOOS Pain, 0.31 for KOOS-PS, and 0.16 for KOOS QOL. WK, Rominger In the middle layer, there are radially oriented fibers that give additional resistance to hoop stresses. In a secondary analysis of the ChAMP (Chondral Lesions and Meniscus Procedures) randomized controlled trial, obesity was identified as a risk factor for worse outcomes, which is consistent with our finding that higher BMI was associated with worse outcomes for all patient-reported outcomes1. Candidate variables were removed if a decrease in the AIC was observed. Comparable rates of progression of radiographic-demonstrated knee osteoarthritis were noted between both treatments. A detailed description of the physical therapy protocol can be found in the eAppendix in Supplement 2. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. While only 42% to 46% of the general population has both ligaments, at least one is present in nearly all patients.[3]. Patients did not receive financial compensation for participating in the study. aThe number of patients screened for eligibility was not available. Question et al; FIDELITY (Finnish Degenerative Meniscus Lesion Study) Investigators. The mean age was 55 years, 45.5% of patients were female, and the mean BMI was 30 kg/m2. The sample size was calculated for the primary end point, which was the 2-year follow-up. Over the 5 years of follow-up, the overall crude between-group difference was 3.5 points (95% CI, 0.7-6.3 points; P<.001 for noninferiority) and was 3.8 points (95% CI, 0.8-6.8; P<.001 for noninferiority) after adjusting for confounding factors. We added our 5-year follow-up statistical analysis plan to the trial registration on October 6, 2021, before data analyses commenced. [12]Insufficient suctioning of excess saline and/or blood at the conclusion of the procedure can contribute to this occurrence. 2001 Jul;24(3):68-86. The camera is taken distally to examine the patellofemoral joint followed by the lateral gutter and popliteal hiatus. We planned to assess symptomatic knee OA at the 5-year follow-up but found no consensus on cutoff values for symptomatic knee OA in the literature. We classified articular cartilage status for the medial, lateral, and patellofemoral compartments according to the following categories. The study by Katz et al14 found a 5 times higher risk for total knee replacement (ie, the treatment for end-stage knee OA) after surgery vs exercise-based physical therapy. Nearly 1 million knee arthroscopic procedures are performed in the United States each year, and arthroscopic partial meniscectomy (APM) is the most common 1.Some randomized trials have shown that APM is no better than sham surgery 2 or conservative treatment that includes physical therapy for treatment of a symptomatic meniscal tear 3-5.Other studies have shown more treatment failures in . Knee arthroscopic surgery in middle-aged patients with meniscal symptoms: a 5-year follow-up of a prospective, randomized study. No other disclosures were reported. Multivariable modeling shows that baseline score was the strongest predictor of improvement in the 1-year follow-up scores for all outcome measures (VR-12 PCS, KOOS Pain, KOOS-PS, and KOOS QOL), with a lower baseline score predicting a larger improvement. The impact of interventions to address these modifiable factors warrants further study. doi:10.1001/jamanetworkopen.2022.20394. 1 Citations Metrics Abstract Background This study aimed to evaluate the efficacy of viscosupplementation after arthroscopic partial meniscectomy. EuroQola new facility for the measurement of health-related quality of life. NJ, Risberg Epub 2016 Feb 13 [PubMed PMID: 26882967], Dias JM, Mazuquin BF, Mostagi FQ, Lima TB, Silva MA, Resende BN, Borges da Silva RM, Lavado EL, Cardoso JR. Successful response to treatment was defined as an improvement of 10 points in either KOOS Pain or KOOS-PS. Predictors and outcomes of crossover to surgery from physical therapy for meniscal tear and osteoarthritis: a randomized trial comparing physical therapy and surgery. We classified reactive synovitis as present or absent. Email address for K.P. The last, most superficial layer is composed of fibers parallel to the meniscal surface that allow for smoother gliding of the knee during motion. The next meniscus tear happened many years later, in my thirties, after a seemingly innocent move. Patients with a locked knee or a displaced portion of meniscal tissue would typically undergo a surgical procedure before completing a course of physical therapy. Review the potential complications of a meniscectomy. HY, Harris Arthroscopic partial meniscectomy is the most common orthopedic procedure performed in the United States. Once the torn meniscus is resected sufficiently, the meniscal biter is replaced with an arthroscopic shaver. Common surgical approaches to treating meniscus tears include partial meniscectomy, meniscal repair, and meniscus transplant. In the intention-to-treat analysis, patients were analyzed in 2 groups according to their randomly allocated treatment. 16. The American journal of sports medicine. We observed a small and comparable progression of knee OA in both groups. In the meniscectomy cohort, 9 patients (18%) progressed to TKA and were therefore considered to have experienced failure. JJ, van Tienen We assessed pain intensity and quality of life at baseline, 3 months, 6 months, 1 year, 2 years, and 5 years and physical function using the KOOS-PS only at the 5-year follow-up. Despite this, many patientshave minimal knowledge with regard to meniscal injuries orpossible treatment options. Epub [PubMed PMID: 31767101], Fox AJ, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA. Epub [PubMed PMID: 30247309], Makris EA, Hadidi P, Athanasiou KA. It is typically performed on older patients with meniscal tears that are degenerative in nature. Interventions APM or placebo surgery (diagnostic knee arthroscopy). IA, Agoritsas Describe the technique required for a meniscectomy. An individualized decision between physical therapy or surgery for patients with degenerative meniscal tears cannot be based on continuous treatment selection markers: a marker-by-treatment analysis of the ESCAPE study. The work cannot be changed in any way or used commercially without permission from the journal. A positive value indicates greater improvement on the IKDC questionnaire in the arthroscopic partial meniscectomy group compared with the physical therapy group. Variable reduction was only performed if rules with regard to the ratio between the degrees of freedom of the observations and number of events, according to Harrell, were violated17. H. M, Loose After adjusting for confounders, there was a mean between-group difference of 3.4 points on the IKDC questionnaire (95% CI, 0.7 to 7.4 points; P<.001 for noninferiority). [10]Additionally, patients with significant osteoarthritis on imaging typically do poorly with partial meniscectomy. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. We based our sample size on an SD of 18 points on the IKDC questionnaire, a power of 90%, a 2-sided of .05, and a noninferiority margin of 8 points on the IKDC questionnaire. The primary outcome was patient-reported knee function (International Knee Documentation Committee Subjective Knee Form (range, 0 [worst] to 100 [best]) during 5 years of follow-up based on the intention-to-treat principle, with a noninferiority threshold of 11 points. Of 321 patients (mean [SD] age, 58 [6.6] years; 161 women [50.2%]), 278 patients (87.1%) completed the 5-year follow-up with a mean follow-up time of 61.8 months (range, 58.8-69.5 months). This approach reflects clinical practice, and blinding the assessor strengthened the comparison between treatments. The etiology of chondromalacia patellae. Recently, two studies where patients were allocated to surgical or non-surgical treatment by chance (i.e. Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial. The severity for each item was scored with an ordered categorical grade (grade 0, normal; grade 1, mild change in joint space or osteophytes; grade 2, moderate change in joint space or osteophytes; and grade 3, severe change in joint space or osteophytes). [Complications of knee arthroscopy]. ERA, Koter Epub [PubMed PMID: 26486644], Small NC. The likelihood of total knee arthroplasty following arthroscopic surgery for osteoarthritis: a systematic review. The primary aim of this study was to compare patient-reported knee function at the 5-year follow-up after arthroscopic partial meniscectomy and exercise-based physical therapy in patients with a degenerative meniscal tear. 2018 Feb;34(2):530-5. Open Access: This is an open access article distributed under the terms of the CC-BY License. 5. Trial Registration AA, van den Ende How do you tear the meniscus? The crude and adjusted intervention effects for all time points are presented in Table 2. We tested for noninferiority based on a 1-sample z test with respect to the noninferiority threshold of 11 points and 1-sided level of 0.025. After surgery, all patients received written postoperative instructions, including a home exercise program. JJ, Anderson For a meniscus repair, you may have to be non-weight-bearing for six to 12 weeks. From baseline to 5-year follow-up, the mean (SD) improvement was 29.6 (18.7) points in the surgery group and 25.1 (17.8) points in the physical therapy group. JN, Brophy If a patient was not able or willing to complete a questionnaire at a specific time point, efforts were made to collect data for the subsequent time points. T, Zhu They are also important for normal gait and stability of the knee. LE, Beard E. R. A. Arkel, B. J. W. Thomassen (Department of Human and Technology, The Hague University of Applied Sciences, Den Haag, The Netherlands). The mean age was 55 years, 46% of patients were female, and the mean BMI was 30 kg/m2. et al. A probe is inserted through the inferomedial portal to assess the integrity of the meniscus. , EuroQol Group. *A list of the Cleveland Clinic Sports Health members for this work is given as a note at the end of the article. Patients who did not undergo their allocated treatment (either surgery or completion of physical therapy) were excluded from the as-treated analysis. Please try after some time. These findings support our findings of worse medial compartment osteoarthritis being associated with worse outcomes, but demonstrate that the heterogeneity between various studies makes a comparison of results problematic. The surgery requires a few small incisions and takes about an hour. Significance was set at p < 0.05. Patients allocated to arthroscopic partial meniscectomy received arthroscopic partial meniscectomy within 4 weeks after randomization at the hospital of inclusion. Terms of Use| It is typically performed on older patients with meniscal tears that are degenerative in nature. The purpose of this study was to study the clinical and radiographic changes in the knee after arthroscopic partial meniscectomy (APM) at a long-term follow-up compared with the contralateral knee. compared outcomes up to 5 years of patients with atraumatic, degenerative meniscal tears between a non-operative group and an arthroscopic partial meniscectomy group. 2nd ed. Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in Adults With Degenerative Meniscal Tears, Figure 2. International Knee Documentation Committee (IKDC) Subjective Knee Form Questionnaire Scores During Follow-up, Figure 3. 19. To compare the 5-year effectiveness of arthroscopic partial meniscectomy and exercise-based physical therapy on patient-reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscal tear. Secured browser on the server 2011 Oct:32 ( 30 ):7411-31. doi: 10.1016/j.biomaterials.2011.06.037 common operation to remove or a! 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( 5 ):1138-43. et al ; ESCAPE Research group increase the of... We did not undergo their allocated treatment prospectively enrolled 665 patients who did not register noninvasive additional treatments knee! Should consider exam findings and clinical decision making ( KOOS-PS ) an OARSI/OMERACT initiative Health members for this is!
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