Functional Outcomes of Arthroscopic Partial Meniscectomy Versus Physical Therapy for Degenerative Meniscal Tears Using a Patient-Specific Score: A Randomized Controlled Trial.

Autor:	Noorduyn JCA; Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands., Glastra van Loon T; Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands., van de Graaf VA; Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands., Willigenburg NW; Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands., Butter IK; Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands., Scholten-Peeters GGM; Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Coppieters MW; Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia., Poolman RW; Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.; Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands., Scholtes VAB; 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., Mutsaerts ELAR; 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., Krijnen MR; 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., Moojen DJF; 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., van Deurzen DFP; 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., Bloembergen CH; 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., Wolkenfelt J; 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., de Gast A; 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., Snijders T; 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., Saris DBF; 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., Wolterbeek N; 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., Neeter C; 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., Kerkhoffs GMMJ; 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., Peters RW; 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., van den Brand ICJB; 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., de Vos-Jakobs S; 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., Spoor AB; 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., Gosens T; 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., Rezaie W; 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., Hofstee DJ; 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., Burger BJ; 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., Haverkamp D; 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., Vervest AMJS; 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., van Rheenen TA; 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., Wijsbek AE; 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., van Arkel ERA; 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., Thomassen BJW; 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., Sprague S; 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., van Tulder MW; 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., Schavemaker M; 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., van Dijk R; 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., van der Kraan J; 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.
Jazyk:	angličtina
Zdroj:	Orthopaedic journal of sports medicine [Orthop J Sports Med] 2020 Oct 29; Vol. 8 (10), pp. 2325967120954392. Date of Electronic Publication: 2020 Oct 29 (Print Publication: 2020).
DOI:	10.1177/2325967120954392
Abstrakt:	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/m 2 , 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). Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Funding for the ESCAPE trial was provided by the Netherlands Organization for Health Research and Development (ZonMw; grant 837002009), Zilveren Kruis (grant Z436), and the foundation of medical research of OLVG (grant 15u.025). The funders had no role in designing and conducting this study; the collection, management, analysis, and interpretation of the data; the preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. (© The Author(s) 2020.)
Databáze:	MEDLINE
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