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Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 10-Year Follow-up of a Prospective, Randomized Controlled Trial.
- Source :
-
American Journal of Sports Medicine . Jul2024, Vol. 52 Issue 9, p2250-2259. 10p. - Publication Year :
- 2024
-
Abstract
- Background: Short- and midterm evaluations of arthroscopic meniscal surgery have shown little or no effect in favor of surgery, although long-term effects, including radiographic changes, are unknown. Purpose: To compare the 10-year outcomes in middle-aged patients with meniscal symptoms between a group that received an exercise program alone and a group that received knee arthroscopy in addition to the exercise program with respect to the prevalence of radiographic and symptomatic osteoarthritis (OA), patient-reported outcomes, and clinical status. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to undergo either 3 months of exercise therapy (nonsurgery group) or knee arthroscopy in addition to the exercise therapy (surgery group). Surgery usually consisted of partial meniscectomy (n = 56) or diagnostic arthroscopy (n = 8). Radiographs were assessed according to the Kellgren-Lawrence score at the baseline and 5- and 10-year follow-ups. Patient-reported outcome measures were reported at the baseline and 1-, 3-, 5-, and 10-year follow-ups. Clinical status was assessed at a 10-year follow-up. The primary outcomes were radiographic OA and changes in the Knee injury and Osteoarthritis Outcome Score Pain subscale (KOOSPAIN) from the baseline to the 10-year follow-up. The primary analysis was performed using the intention-to-treat approach. Results: At the time of the 10-year follow-up, eight patients had died, leaving 142 eligible patients. Radiographic OA was assessed for 95 patients (67%), questionnaires were answered by 110 (77%), and the clinical status was evaluated for 95 (67%). Radiographic OA was present in 67% of the patients in each group (P ≥.999); symptomatic OA was present in 47% of the nonsurgery group and 57% of the surgery group (P =.301). There were no differences between groups regarding changes from baseline to 10 years in any of the KOOS subscales. Conclusion: Knee arthroscopic surgery, in most cases consisting of partial meniscectomy or diagnostic arthroscopy, in addition to exercise therapy in middle-aged patients with meniscal symptoms, did not increase the rates of radiographic or symptomatic OA and resulted in similar patient-reported outcomes at the 10-year follow-up compared with exercise therapy alone. Considering the short-term benefit and no long-term harm from knee arthroscopic surgery, the treatment may be recommended when first-line treatment—including exercise therapy for ≥3 months—does not relieve patient's symptoms. Registration: Clinical Trials NCT01288768 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]
- Subjects :
- *MENISCUS injuries
*KNEE osteoarthritis
*PHYSICAL therapy
*WEIGHT-bearing (Orthopedics)
*STATISTICAL models
*REPEATED measures design
*PAIN measurement
*KNEE pain
*ACADEMIC medical centers
*MEASUREMENT of angles (Geometry)
*T-test (Statistics)
*DATA analysis
*ARTHROSCOPY
*EXERCISE therapy
*STATISTICAL sampling
*QUESTIONNAIRES
*FISHER exact test
*VISUAL analog scale
*SYMPTOMS
*RANDOMIZED controlled trials
*TREATMENT effectiveness
*DISEASE prevalence
*CHI-squared test
*DESCRIPTIVE statistics
*LONGITUDINAL method
*KNEE joint
*DISEASE complications
*STATISTICS
*GERIATRIC assessment
*QUALITY of life
*HEALTH outcome assessment
*DATA analysis software
*CONFIDENCE intervals
*MENISCECTOMY
*RANGE of motion of joints
*DISEASE progression
*MIDDLE age
Subjects
Details
- Language :
- English
- ISSN :
- 03635465
- Volume :
- 52
- Issue :
- 9
- Database :
- Academic Search Index
- Journal :
- American Journal of Sports Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 178911919
- Full Text :
- https://doi.org/10.1177/03635465241255653