An individualized decision between physical therapy or surgery for patients with degenerative meniscal tears cannot be based on continuous treatment selection markers: a marker-by-treatment analysis of the ESCAPE study

Noorduyn, Julia C A; Graaf, Victor A. van de; Willigenburg, Nienke W.; Scholten-Peeters, Gwendolyne G. M.; Heymans, Martijn W.; Coppieters, Michel W.; Poolman, Rudolf W.; Scholtes, Vanessa A.; Mutsaerts, Eduard L. A. R.; Krijnen, Matthijs R.; Deurzen, Derek F.P. van; Moojen, Dirk Jan F; Bloembergen, Coen H; Gast, Arthur de; Snijders, Thom E; Halma, Jelle J.; Saris, Daniël B.F.; Wolterbeek, Nienke; Neeter, Camille; Kerkhoffs, Gino M. M. J.; Peters, Rolf W.; Brand, Igor C.J.B. van den; Vos-Jakobs, Suzanne de; Spoor, A. B.; Gosens, Taco; Rezaie, Wahid; Hofstee, Dirk Jan; Burger, Bart J.; Haverkamp, Daniël; Vervest, A. M. J. S.; Rheenen, Thijs A. van; Wijsbek, Anne E.; Arkel, Ewoud R.A. van; Thomassen, Bregje J.W.; Sprague, Sheila; Mol, Ben Willem J.; Schavemaker, Mirjam; Wolkenfelt, Julius; Teuwen, M.; Butter, Ise K; Tulder, Maurits W. van

doi:10.1007/s00167-021-06851-x

Cited by 6 publications

(9 citation statements)

References 32 publications

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“…Previous studies investigated specific patient characteristics and combinations of characteristics to estimate treatment outcome and possible subgroups of patient who will benefit more from surgery compared with physical therapy. [31][32][33][34] However, none of these studies were able to find such a subgroup of patients. This finding is in line with ours, showing that physical therapy is noninferior to arthroscopic partial meniscectomy in patients with degenerative meniscal tears.…”

Section: Discussionmentioning

confidence: 95%

“…Furthermore, we checked for confounding effects within our primary outcomes, and our adjusted analyses are in line with our primary unadjusted results. Previous studies investigated specific patient characteristics and combinations of characteristics to estimate treatment outcome and possible subgroups of patient who will benefit more from surgery compared with physical therapy . However, none of these studies were able to find such a subgroup of patients.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears

et al. 2022

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Key Points Question Is exercise-based physical therapy noninferior to arthroscopic partial meniscectomy during a 5-year follow-up period in patients aged 45 to 70 years with a degenerative meniscal tear? Findings In this noninferiority randomized clinical trial, no significant or clinically relevant between-group difference in patient-reported knee function was noted on the International Knee Documentation Committee Subjective Knee Form at the 5-year follow-up. Physical therapy was not inferior to arthroscopic partial meniscectomy. Meaning The findings of this trial support the recommendation that exercise-based physical therapy should be the preferred treatment over surgery for degenerative meniscal tears.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears

et al. 2022

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“…Although they investigated a number of preoperative factors, including patient demographics and knee-related symptoms, the predictive performance of the prognostic model was poor [ 21 ]. Noorduyn et al also found that there was no clear subgroup of patients who would benefit from either surgery or physical therapy for a degenerative meniscal tear [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies attempted to identify a subgroup of patients who could show particularly favorable surgical outcomes after APM [ 21 , 22 ]. If surgeons preoperatively distinguish between those who would benefit from APM and those who would not, unnecessary surgery could be avoided and the outcomes of APM will be improved.…”

Section: Introductionmentioning

confidence: 99%

Hidden Unstable Flap Should Be Suspected in Treating Intractable Pain from Medial Meniscus Horizontal Tear

Kim

Joo²,

An³

et al. 2022

JCM

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(1) Background: The medial meniscus horizontal tear (MMHT) is known as a lesion that can be treated nonoperatively. However, some patients show persistent pain despite conservative treatments. In arthroscopic surgery for MMHT, surgeons often encounter unexpected unstable flaps, which can explain the intractable pain. This study aimed to determine whether preoperative factors could predict the hidden unstable flaps in MMHT. (2) Materials and Methods: Medical records of 65 patients who underwent arthroscopic partial meniscectomy (APM) for isolated MMHT during 2016–2020 were retrospectively reviewed. APM was indicated when there was no severe chondral degeneration and intractable localized knee pain in the medial compartment did not resolve despite conservative treatments. Unstable flap was confirmed based on arthroscopic images and operation notes. Each of the following preoperative factors were investigated using logistic regression analyses to determine whether they can predict an unstable flap: age, sex, body mass index, lower limb alignment, trauma history, mechanical symptoms, symptom duration, visual analogue scale (VAS), Lysholm score, cartilage wear of the medial compartment, and subchondral bone marrow lesion (BML). (3) Results: Hidden unstable flaps were noted in 45 (69.2%) patients. Based on univariate analyses for each preoperative factor, age, symptom duration, cartilage wear (of the femoral condyle and the tibial plateau), and subchondral BML were included in the multivariate logistic regression analysis. The results showed that symptom duration (p = 0.026, odds ratio = 0.99) and high-grade cartilage wear of the medial femoral condyle (p = 0.017, odds ratio = 0.06) were negatively associated with unstable flaps. A receiver operating characteristic curve was used to calculate the symptom duration at which the prediction of unstable flaps was maximized, and the cutoff point was 14.0 months. (4) Conclusions: More than two thirds of patients suffering intractable pain from MMHT had hidden unstable flaps. However, APM should not be considered when the symptom duration is more than 14 months or high-grade cartilage wear of the medial femoral condyle is noted.

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“…In assessing the outcomes of medial MAT, degenerative tears that occur in the late postoperative period should be analyzed separately because such tears are often asymptomatic. 20,31 Degenerative graft tears would have to be evaluated in the long term to verify their effects on the MAT survivorship. The present study tried to investigate the association between the long-term survival rate of medial MAT and graft tears.…”

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confidence: 99%

Risk Factor for Clinical Failure of Medial Meniscal Allograft Transplant: Early vs Late Graft Tear

Song,

Kim,

Bin

et al. 2024

Am J Sports Med

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Background: Graft tears are common postoperative findings in meniscal allograft transplant (MAT). Graft tear in medial MAT may be different from that of lateral MAT, considering the difference between medial meniscal tears and lateral meniscal tears. Moreover, medial MAT is frequently accompanied by ligament reconstruction, which is associated with graft tear. The effect of graft tear on the long-term survivorship of medial MAT has not been investigated. Hypothesis: Graft tear would adversely affect the survivorship of medial MAT and the effect would be different according to the timing of graft tear. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 55 patients undergoing medial MAT between June 2019 and March 2000 were retrospectively reviewed. Postoperative magnetic resonance imaging (MRI) scans were reviewed to identify graft tears, and the timing of their occurrence was investigated. Postoperative MRI was performed routinely during the first postoperative year and every 2 years thereafter. The patients were classified into a no graft tear (NT) group, early graft tear (occurring within 1 year; ET) group, and late graft tear (occurring 1 year after surgery; LT) group. The survival rate of medial MAT was estimated according to graft tear, with a failure being defined as (1) reoperations including arthroplasty, realignment osteotomy, revision MAT, and meniscectomy (>50% of the graft or to the zone of the meniscocapsular junction) or (2) Lysholm score <65. Clinical scores were compared between the groups. Results: The mean follow-up duration was 8.6 ± 5.3 years. During that period, clinical failures occurred in 6 (10.9%) patients. The overall survival rate at 5 years was 94.0% (95% CI, 90.6%-97.4%). Graft tears were seen in 18 patients: 6 patients in the ET group and 12 patients in the LT group. The median time when the graft tear was noted on MRI scans was 5.5 months (range, 1-11 months) postoperatively in the ET group and 99.5 months (range, 19-264 months) postoperatively in the LT group. Five patients in the ET group had root tears, whereas 9 patients in the LT group had complex or horizontal tears. The 5-year survival rate of the ET group was 62.5% (95% CI, 41.2%-83.8%), which was significantly lower than that of the NT group (96.8%; 95% CI, 93.6%-99.9%) and the LT group (85.7%; 95% CI, 72.5%-98.9%; P = .002). The mean postoperative Lysholm scores were 85.6 ± 17.9 in the NT group, 93.0 ± 2.8 in the ET group, and 79.3 ± 11.6 in the LT group, showing no significant difference between the groups (Kruskal-Wallis test, P = .058). Conclusion: Clinical relevance of graft tear that occurred after medial MAT was dependent upon its timing. ET was a risk factor for clinical failure, whereas LT did not adversely affect graft survivorship. Lysholm scores did not differ according to graft tear.

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An individualized decision between physical therapy or surgery for patients with degenerative meniscal tears cannot be based on continuous treatment selection markers: a marker-by-treatment analysis of the ESCAPE study

Cited by 6 publications

References 32 publications

Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears

Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears

Hidden Unstable Flap Should Be Suspected in Treating Intractable Pain from Medial Meniscus Horizontal Tear

Risk Factor for Clinical Failure of Medial Meniscal Allograft Transplant: Early vs Late Graft Tear

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