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Noorduyn JCA, Glastra van Loon T, van de Graaf VA, Willigenburg NW, Butter IK, Scholten-Peeters GGM, Coppieters MW, Poolman RW, Scholtes VAB, Mutsaerts ELAR, Krijnen MR, Moojen DJF, van Deurzen DFP, Bloembergen CH, Wolkenfelt J, de Gast A, Snijders T, Saris DBF, Wolterbeek N, Neeter C, Kerkhoffs GMMJ, Peters RW, van den Brand ICJB, de Vos-Jakobs S, Spoor AB, Gosens T, Rezaie W, Hofstee DJ, Burger BJ, Haverkamp D, Vervest AMJS, van Rheenen TA, Wijsbek AE, van Arkel ERA, Thomassen BJW, Sprague S, van Tulder MW, Schavemaker M, van Dijk R, van der Kraan J. Functional Outcomes of Arthroscopic Partial Meniscectomy Versus Physical Therapy for Degenerative Meniscal Tears Using a Patient-Specific Score: A Randomized Controlled Trial. Orthop J Sports Med 2020; 8:2325967120954392. [PMID: 33195707 PMCID: PMC7607803 DOI: 10.1177/2325967120954392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 02/04/2023] Open
Abstract
Background It is unknown whether the treatment effects of partial meniscectomy and physical therapy differ when focusing on activities most valued by patients with degenerative meniscal tears. Purpose To compare partial meniscectomy with physical therapy in patients with a degenerative meniscal tear, focusing on patients' most important functional limitations as the outcome. Study Design Randomized controlled trial; Level of evidence, 1. Methods This study is part of the Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE) trial, a multicenter noninferiority randomized controlled trial conducted in 9 orthopaedic hospital departments in the Netherlands. The ESCAPE trial included 321 patients aged between 45 and 70 years with a symptomatic, magnetic resonance imaging-confirmed meniscal tear. Exclusion criteria were severe osteoarthritis, body mass index >35 kg/m2, locking of the knee, and prior knee surgery or knee instability due to an anterior or posterior cruciate ligament rupture. This study compared partial meniscectomy with physical therapy consisting of a supervised incremental exercise protocol of 16 sessions over 8 weeks. The main outcome measure was the Dutch-language equivalent of the Patient-Specific Functional Scale (PSFS), a secondary outcome measure of the ESCAPE trial. We used crude and adjusted linear mixed-model analyses to reveal the between-group differences over 24 months. We calculated the minimal important change for the PSFS using an anchor-based method. Results After 24 months, 286 patients completed the follow-up. The partial meniscectomy group (n = 139) improved on the PSFS by a mean of 4.8 ± 2.6 points (from 6.8 ± 1.9 to 2.0 ± 2.2), and the physical therapy group (n = 147) improved by a mean of 4.0 ± 3.1 points (from 6.7 ± 2.0 to 2.7 ± 2.5). The crude overall between-group difference showed a -0.6-point difference (95% CI, -1.0 to -0.2; P = .004) in favor of the partial meniscectomy group. This improvement was statistically significant but not clinically meaningful, as the calculated minimal important change was 2.5 points on an 11-point scale. Conclusion Both interventions were associated with a clinically meaningful improvement regarding patients' most important functional limitations. Although partial meniscectomy was associated with a statistically larger improvement at some follow-up time points, the difference compared with physical therapy was small and clinically not meaningful at any follow-up time point. Registration NCT01850719 (ClinicalTrials.gov identifier) and NTR3908 (the Netherlands Trial Register).
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Affiliation(s)
| | | | | | | | - Ise K Butter
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michel W Coppieters
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Vanessa A B Scholtes
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Eduard L A R Mutsaerts
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Matthijs R Krijnen
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Dirk Jan F Moojen
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Derek F P van Deurzen
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Coen H Bloembergen
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Julius Wolkenfelt
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Arthur de Gast
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Thom Snijders
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Daniel B F Saris
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Camille Neeter
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Rolf W Peters
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Igor C J B van den Brand
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Suzanne de Vos-Jakobs
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Andy B Spoor
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Taco Gosens
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Wahid Rezaie
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Dirk Jan Hofstee
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Bart J Burger
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Daniel Haverkamp
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Anton M J S Vervest
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Thijs A van Rheenen
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Anne E Wijsbek
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Ewoud R A van Arkel
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Bregje J W Thomassen
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Sheila Sprague
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Maurits W van Tulder
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Mirjam Schavemaker
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Rogier van Dijk
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - J van der Kraan
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Investigation performed at the Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
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