Degenerative meniscus tears - assimilation of evidence and consensus statements across three continents: state of the art

Stone, James W.; Salzler, Matthew J.; Parker, David; Becker, Roland; Harner, Christopher D.

doi:10.1136/jisakos-2015-000003

Cited by 23 publications

(51 citation statements)

References 80 publications

(34 reference statements)

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“…Normative mean (SD) values for the IKDC in the United States are 88(14) for men aged 51 to 65 years and 85(16) for women aged 51 to 65 years in a population without current knee problems or a history of knee surgery. In a mixed population of people with and without current knee problems, the normative mean (SD) scores are 77 (23) for men aged 51 to 65 years and 71(26) for women aged 51 to 65 years.…”

mentioning

confidence: 99%

Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears

Graaf

Noorduyn

Willigenburg

et al. 2018

JAMA

138

191

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; for the ESCAPE Research Group IMPORTANCE Despite recent studies suggesting arthroscopic partial meniscectomy (APM) is not more effective than physical therapy (PT), the procedure is still frequently performed in patients with meniscal tears. OBJECTIVE To assess whether PT is noninferior to APM for improving patient-reported knee function in patients with meniscal tears. DESIGN, SETTING, AND PARTICIPANTS Noninferiority, multicenter, randomized clinical trial conducted in 9 hospitals in the Netherlands. Participants were aged 45 to 70 years with nonobstructive meniscal tears (ie, no locking of the knee joint). Patients with knee instability, severe osteoarthritis, and body mass index greater than 35 were excluded. Recruitment took place between July 17, 2013, and November 4, 2015. Participants were followed up for 24 months (final participant follow-up, October 11, 2017). INTERVENTIONS Three hundred twenty-one participants were randomly assigned to APM (n = 159) or a predefined PT protocol (n = 162). The PT protocol consisted of 16 sessions of exercise therapy over 8 weeks focused on coordination and closed kinetic chain strength exercises. MAIN OUTCOMES AND MEASURES The primary outcome was change in patient-reported knee function on the International Knee Documentation Committee Subjective Knee Form (range, 0 to 100; from worse to best) from baseline over a 24-month follow-up period. The noninferiority margin was defined as a difference between treatment groups of 8 points and was assessed with a 1-sided α of .025. The primary analysis followed the intention-to-treat principle. RESULTS Among 321 patients who were randomized (mean [SD] age, 58 [6.6] years; 161 women [50%]), 289 (90%) completed the trial (161 women and 158 men). In the PT group, 47 participants (29%) had APM during the 24-month follow-up period, and 8 participants randomized to APM (5%) did not have APM. Over a 24-month follow-up period, knee function improved in the APM group by 26.2 points (from 44.8 to 71.5) and in the PT group by 20.4 points (from 46.5 to 67.7). The overall between-group difference was 3.6 points (97.5% CI, −ϱ to 6.5; P value for noninferiority = .001). Adverse events occurred in 18 participants in the APM group and 12 in the PT group. Repeat surgery (3 in the APM group and 1 in the PT group) and additional outpatient visits for knee pain (6 in the APM group and 2 in the PT group) were the most frequent adverse events. CONCLUSIONS AND RELEVANCE Among patients with nonobstructive meniscal tears, PT was noninferior to APM for improving patient-reported knee function over a 24-month follow-up period. Based on these results, PT may be considered an alternative to surgery for patients with nonobstructive meniscal tears.

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mentioning

confidence: 99%

Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears

Graaf

Noorduyn

Willigenburg

et al. 2018

JAMA

138

191

View full text Add to dashboard Cite

show abstract

“…Although debate persists on the additional value of an economic evaluation in case of no difference in effectiveness, differences in costs could be missed if an economic analysis is not performed, nor can non-inferiority be investigated 22. Our data will further assist clinicians and healthcare decision makers in efficiently allocating already scarce healthcare resources23 and will likely contribute to reducing healthcare costs 24. Rongen and colleagues4 reported the results of a model-based economic evaluation in which they compared APM with matched controls.…”

Section: Discussionmentioning

confidence: 95%

How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study

Graaf

Dongen²,

Willigenburg

et al. 2019

Br J Sports Med

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ObjectivesTo examine whether physical therapy (PT) is cost-effective compared with arthroscopic partial meniscectomy (APM) in patients with a non-obstructive meniscal tear, we performed a full trial-based economic evaluation from a societal perspective. In a secondary analysis—this paper—we examined whether PT is non-inferior to APM.MethodsWe recruited patients aged 45–70 years with a non-obstructive meniscal tear in nine Dutch hospitals. Resource use was measured using web-based questionnaires. Measures of effectiveness included knee function using the International Knee Documentation Committee (IKDC) and quality-adjusted life-years (QALYs). Follow-up was 24 months. Uncertainty was assessed using bootstrapping techniques. The non-inferiority margins for societal costs, the IKDC and QALYs, were €670, 8 points and 0.057 points, respectively.ResultsWe randomly assigned 321 patients to PT (n=162) or APM (n=159). PT was associated with significantly lower costs after 24 months compared with APM (−€1803; 95% CI −€3008 to −€838). The probability of PT being cost-effective compared with APM was 1.00 at a willingness to pay of €0/unit of effect for the IKDC (knee function) and QALYs (quality of life) and decreased with increasing values of willingness to pay. The probability that PT is non-inferior to APM was 0.97 for all non-inferiority margins for the IKDC and 0.89 for QALYs.ConclusionsThe probability of PT being cost-effective compared with APM was relatively high at reasonable values of willingness to pay for the IKDC and QALYs. Also, PT had a relatively high probability of being non-inferior to APM for both outcomes. This warrants further deimplementation of APM in patients with non-obstructive meniscal tears.Trial registration numbersNCT01850719 and NTR3908.

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“…Meniscal treatment guidelines have previously been issued by surgical expert groups including the American Orthopaedic Society for Sports Medicine (AOSSM) and Arthroscopy Association of North America (AANA) [16], the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) [31], and International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) [14]. These statements were previously limited by a lack of agreement on the terminology applicable to their target population.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, following the publication of several randomised controlled clinical trials, there has been debate about the effectiveness of this procedure [8][9][10][11][12][13]. Interpretation of the evidence has, however, been hampered by inconsistent and broad inclusion criteria, with specialists arguing that the patients selected would not be considered eligible for surgery in contemporary practice [10,14,15].…”

Section: Introductionmentioning

confidence: 99%

“…The pattern of symptoms is thought to be critical to the identification of patients with a meniscal origin for their knee pain, with the importance of corresponding 'mechanical' symptoms being particularly frequently highlighted [10,12,[16][17][18][19][20]. Despite this, no definition for these symptoms has been agreed [14]. Furthermore, given that many meniscal tears are asymptomatic, the importance of the anatomical pattern of meniscal tear and the presence or absence of radiographic osteoarthritis has also been highlighted [21,22].…”

Section: Introductionmentioning

confidence: 99%

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National consensus on the definition, investigation, and classification of meniscal lesions of the knee

2018

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Degenerative meniscus tears - assimilation of evidence and consensus statements across three continents: state of the art

Cited by 23 publications

References 80 publications

Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears

Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears

How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study

National consensus on the definition, investigation, and classification of meniscal lesions of the knee

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