Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial

B Berg; E M Roos; M Englund; N J Kise; A Tiulpin; S Saarakkala; L Engebretsen; C N Eftang; I Holm; M A Risberg

doi:10.1016/j.joca.2020.01.020

Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial

Osteoarthritis Cartilage. 2020 Jul;28(7):897-906. doi: 10.1016/j.joca.2020.01.020. Epub 2020 Mar 14.

Authors

B Berg¹, E M Roos², M Englund³, N J Kise⁴, A Tiulpin⁵, S Saarakkala⁶, L Engebretsen⁷, C N Eftang⁸, I Holm⁹, M A Risberg¹⁰

Affiliations

¹ Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway. Electronic address: bjornar.berg@studmed.uio.no.
² Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. Electronic address: eroos@health.sdu.dk.
³ Faculty of Medicine, Department of Clinical Sciences, Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden. Electronic address: martin.englund@med.lu.se.
⁴ Department of Orthopedic Surgery, Martina Hansens Hospital, Sandvika, Norway. Electronic address: ninakise@hotmail.com.
⁵ Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. Electronic address: aleksei.tiulpin@oulu.fi.
⁶ Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. Electronic address: simo.saarakkala@oulu.fi.
⁷ Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway; Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland. Electronic address: lars.engebretsen@medisin.uio.no.
⁸ Department of Pathology, Akershus University Hospital, Lørenskog, Norway. Electronic address: cathri.ne@icloud.com.
⁹ Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway. Electronic address: inger.holm@medisin.uio.no.
¹⁰ Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway. Electronic address: m.a.risberg@nih.no.

PMID: 32184135
DOI: 10.1016/j.joca.2020.01.020

Abstract

Objective: To evaluate progression of individual radiographic features 5 years following exercise therapy or arthroscopic partial meniscectomy as treatment for degenerative meniscal tear.

Design: Randomized controlled trial including 140 adults, aged 35-60 years, with a magnetic resonance image verified degenerative meniscal tear, and 96% without definite radiographic knee osteoarthritis. Participants were randomized to either 12-weeks of supervised exercise therapy or arthroscopic partial meniscectomy. The primary outcome was between-group difference in progression of tibiofemoral joint space narrowing and marginal osteophytes at 5 years, assessed semi-quantitatively by the OARSI atlas. Secondary outcomes included incidence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis, medial tibiofemoral fixed joint space width (quantitatively assessed), and patient-reported outcome measures. Statistical analyses were performed using a full analysis set. Per protocol and as treated analysis were also performed.

Results: The risk ratios (95% CI) for progression of semi-quantitatively assessed joint space narrowing and medial and lateral osteophytes for the surgery group were 0.89 (0.55-1.44), 1.15 (0.79-1.68) and 0.77 (0.42-1.42), respectively, compared to the exercise therapy group. In secondary outcomes (full-set analysis) no statistically significant between-group differences were found.

Conclusion: The study was inconclusive with respect to potential differences in progression of individual radiographic features after surgical and non-surgical treatment for degenerative meniscal tear. Further, we found no strong evidence in support of differences in development of incident radiographic knee osteoarthritis or patient-reported outcomes between exercise therapy and arthroscopic partial meniscectomy.

Trial registration: www.clinicaltrials.gov (NCT01002794).

Keywords: Degenerative meniscal tears; Exercise therapy; Knee arthroscopy; Knee osteoarthritis; Partial meniscectomy; Rehabilitation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Disease Progression
Exercise Therapy / methods*
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Meniscectomy / methods*
Middle Aged
Osteoarthritis, Knee / diagnostic imaging
Osteoarthritis, Knee / epidemiology*
Osteoarthritis, Knee / physiopathology
Osteophyte
Patient Reported Outcome Measures
Physical Therapy Modalities
Tibial Meniscus Injuries / physiopathology
Tibial Meniscus Injuries / therapy*

Associated data

ClinicalTrials.gov/NCT01002794