Surgery to treat traumatic meniscal tear did not offer extra advantage over supervised exercise regimen in younger patients, according to a new study from the University of Southern Denmark.^1,2

A total of 121 patients, aged 18-40 years, with a diagnosis of meniscus tear confirmed on MRI were recruited from seven Danish hospitals for this RCT and monitored for one year; 107 patients completed the scheduled follow-up. The study excluded patients with displaced bucket-handle tears and those with complete ligament rupture. The participants were randomized to either surgery in the form of partial meniscectomy or meniscal repair followed by standard postoperative exercise regimen or supervised exercise (individualized) regimen and education for 12 weeks. The exercise group had the option of surgery later if needed. During the follow-up period, 16 patients (26%) in the exercise group crossed over to surgery, while 8 participants (13%) in the surgical intervention group decided against having the surgery.

Pain, symptoms, function (sport and recreation) and quality of life were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS4) subscales, with scores ranging from 0 (worst) to 100 (best).

Results showed comparable improvements in both the groups. At one year, no statistically significant between-group differences were noted in terms of the KOOS4 scores; 19.2 vs 16.4 in the surgery versus exercise groups, respectively. “One of four from the exercise group eventually had surgery”. The adverse events reported were also equivalent; 4 vs 7 in the surgery and exercise groups, respectively

For the first time, this study conducted in young adults has shown that conservative management was as good as arthroscopy for uncomplicated meniscal tears with similar improvements in pain, function and QOL. Younger patients with meniscal tears now have an evidence-based noninvasive treatment option. Surgery as an option remains available. Søren T. Skou, lead author of the study called the study findings to be “practice-changing” and said that “patients, during shared decision-making with clinicians, can confidently choose both treatment strategies and expect to improve”.²

Reference

1. Søren T. Skou, et al. Early surgery or exercise and education for meniscal tears in young adults. NEJM Evid. Jan. 25, 2022;1(2):EVIDoa2100038. DOI: https://doi.org/10.1056/EVIDoa2100038.
2. Physical therapy as good as surgery for meniscus tears in young adults  - Medscape - Feb 14, 2022.