| DREAM trial : In this pragmatic RCT in active young adults with meniscal tears, early meniscal surgery was not superior to a strategy of supervised exercise therapy and education with the option of subsequent surgery. |
Background
Surgery is commonly used to treat meniscus tears; However, to our knowledge, no randomized controlled trials (RCTs) have compared surgery with non-surgical alternatives in young adults.
We hypothesized that early meniscal surgery would be superior to an exercise and education strategy with the option of later surgery if necessary.
Methods
In this pragmatic parallel-group RCT, we enrolled young adults (aged 18–40 years) with MRI-verified meniscal tears eligible for surgery in seven Danish hospitals.
Patients were randomly assigned (1:1) to surgery (partial meniscectomy or meniscus repair) or 12-week supervised exercise therapy and education with the option of surgery later if necessary.
The primary outcome was the difference in change from baseline to 12 months in the mean score of four Knee Injury and Osteoarthritis Outcome Score (KOOS 4) subscales covering pain, symptoms, function in sport and recreation, and quality of life, with a range from 0 (worst) to 100 (best).
Results
We enrolled 121 young adults (mean age, 29.7 years; 28% were women). In total, 107 participants (88%) completed the 12-month follow-up; 16 participants (26%) in the exercise group crossed over to surgery, while 8 (13%) in the surgery group did not undergo surgery.
Intention-to-treat analysis showed no statistically significant difference in change between groups from baseline to 12 months in KOOS 4 scores (19.2 vs. 16.4 in surgery vs. exercise groups; mean difference adjusted, 5.4 [95% confidence interval, −0.7 to 11.4]).
No differences were observed in serious adverse events (four vs. seven in the surgery and exercise groups, respectively; P = 0.40). Per-protocol and as-treatment analyzes yielded similar results.
Conclusions Our results suggest that among active young adults with meniscal tears, an early meniscal surgery strategy is not superior to an exercise and education strategy with the option of later surgery. Both groups experienced clinically relevant improvements in pain, function and quality of life at 12 months, with one of the four in the exercise group ultimately undergoing surgery. |
(Funded by the Danish Council for Independent Research, IMK Almene Fond, Lundbeck Foundation, Spar Nord Foundation, Danish Rheumatism Association, Association of Danish Physiotherapists Research Fund, Research Council at Næstved-Slagelse-Ringsted Hospitals, and Region Zealand; ClinicalTrials.gov number , NCT02995551.)
