Arthroscopic Partial Meniscectomy Versus Exercise Therapy for Meniscal Injuries in Older Patients, a 5 Year Follow up.

Onze Lieve Vrouwe Gasthuis321 enrolled

Overview

Arthroscopic partial meniscectomie (APM) offers little short-term to medium-term benefit above sham surgery or non-surgical management for knee function in most patients with a symptomatic degenerative meniscus tear. It is suggested that APM is associated with increased risk of accelerated progression of knee osteoarthritis in middle-aged to older patients. With the 5 year follow-up of the ESCAPE trial we will investigate the longterm results of APM and physical therapy in patients with a meniscal tear over 45 years old.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

321

Conditions

Meniscus Tear, Tibial Osteoarthritis, Knee

Interventions

In the surgery group, the orthopaedic surgeon performed an arthroscopic partial meniscectomy within 4 weeks after allocation. The surgeon removed the damaged part of the meniscus, until a stable and solid meniscus remained. All patients received written post-operative instructions. Eight weeks after surgery, patients received a consult in the outpatient orthopaedic clinic. In agreement with the Dutch Orthopaedic Association Guidelines, patients were referred to physical therapy when signs of abnormal recovery were present.

Eligibility

Sex: ALLMin age: 45 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 45 to 70 years old MRI confirmed, non-obstructive and symptomatic meniscal tear Exclusion Criteria: * Knee locking or trauma leading to acute surgery; ▸ Associated injuries on the index knee consisting of: * Symptomatic partial or total tear of the anterior cruciate ligament (ACL), * Posterior cruciate ligament tear, * OA of the knee, grade 4 on the Kellgren and Lawrence Grading Scale, * An injury to the lateral or posterolateral ligament complex with significant laxity; * Previous knee surgery on the index knee (with the exception of diagnostic arthroscopy); * Tumour that is suspected of malignancy, detectable on MRI; * Obesity with a body mass index \>35; * American Society of Anesthesiologists (ASA) class 4 or 5 patients; * General disease that effects physical function or systemic medication/abuse of steroids; * Any other medical condition or treatment interfering with the completion or assessment of the trial, for example, contraindications to MRI or surgery; * Drugs or alcohol abuse; * Patients unable to fill out the Dutch questionnaires.

Outcomes

Primary Outcomes

Knee Documentation Committee Subjective Knee Form (IKDC) questionnaire

Knee Documentation Committee Subjective Knee Form (IKDC) questionnaire to assess patient reported knee functionWe assessed knee OA on radiographs and patient reported frequency of knee pain during activities was assessed as part of the IKDC questionnaire.

Time frame: 60 months

Secondary Outcomes

Radiographic Knee osteoarthritis

The OARSI atlas is a semi-quantitative instrument with focus to assess the severity of joint space narrowing and osteophytes in knee OA. We considered radiographic knee OA if any of the follow three criteria were met: 1) Joint space narrowing of grade 2 or higher; 2) sum of osteophyte grades ≥2 or 3) grade 1 joint space narrowing in combination with a grade 1 osteophyte.

Time frame: 60 months

Symptomatic knee osteoarthritis (OA)

Our main outcome is symptomatic knee osteoarthritis (OA). Symptomatic knee OA is a combination of knee OA assessed on radiograph and patient reported frequency of knee pain. We assessed knee OA on radiographs and patient reported frequency of knee pain during activities was assessed as part of the IKDC questionnaire.

Time frame: 60 months

Patient reported knee pain during weight bearing

Patient reported knee pain during weight bearing assessed on visual analogue scale from 0-100

Time frame: 60 months

Patient reported quality of life

Quality of life assessed by the Euroqol 5 diminesions 5 Levels

Time frame: 60 months