MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although meniscal surgeries are among the most frequently performed surgical procedures in orthopedic surgery, until just recently there were hardly any randomized trials proving its superiority over conservative treatment.
In this randomized clinical trial, including 321 patients with non-obstructive (e.g. no locking of the knee joint) meniscal tears, we found physical therapy non-inferior to arthroscopic partial meniscectomy.
MedicalResearch.com: What should readers take away from your report?
Response: The results of this trial suggest a further reduction of (unnecessary) meniscectomies and that a initial approach with physical therapy may be considered in the treatment of patients with non-obstructive meniscal tears.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Although the intention-to-treat results demonstrated that physical therapy was non-inferior to arthroscopic partial meniscectomy, still approximately 30% of the physical therapy group still received surgery during the 2-year follow-up. Therefore, future research should focus on these non-responders to physical therapy and thereby improve and possibly individualize the conservative treatment program based on patient characteristics. Such would include prediction studies and individual patient data meta-analyses.
Disclosures: For this study, we received financial support from the Netherlands Organization for Health Research and Development (in Dutch: ZonMw), Zilverenkruis Health Insurance, and the Foundation of Medical Research of the OLVG Amsterdam.
van de Graaf VA, Noorduyn JCA, Willigenburg NW, et al. Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal TearsThe ESCAPE Randomized Clinical Trial. JAMA.2018;320(13):1328–1337. doi:10.1001/jama.2018.13308
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