Arthroscopic partial meniscectomy versus physical therapy in older patients with a meniscal tear: one year follow-up results of a randomized controlled trial

Bloembergen, C.H. (2017) Arthroscopic partial meniscectomy versus physical therapy in older patients with a meniscal tear: one year follow-up results of a randomized controlled trial. thesis, Medicine.

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Abstract

OBJECTIVES - The purpose of the present study was to compare the functional outcome of Arthroscopic Partial Meniscectomy (APM) and Physical Therapy (PT) in patients between 45 and 70 years old with a degenerative meniscal tear. Although APM is currently under scrutiny, it is still the most performed surgical procedure in orthopaedic surgery. In this multicentre Randomized Controlled Trial (RCT) we aimed to prove non-inferiority of PT compared with APM. METHODS - We conducted a multicentre randomized controlled trial in seven hospitals in The Netherlands and included 321 participants with an MRI-confirmed symptomatic, non-obstructive meniscal tear. Patients were randomly assigned to either APM or PT. As primary outcome we used the International Knee Documentation Committee ‘Subjective Knee Form’ (IKDC-SKF). Secondary outcomes included the RAND-36, EQ5D5L, Tegner activity scale and patient-specific complaints. Follow-up assessments were performed at 3, 6 and 12 months. For the IKDC, we used a non-inferiority threshold of 8.8 points. RESULTS – After one year, the mean improvement in the IKDC was 25.5 points (95% confidence interval [CI], 22.2 – 28.7) in the APM group and 18.6 (95% CI, 16.0 – 22.0) in the PT group, which resulted in a significant mean difference (MD) of 6.9 points (95% CI, 2.5 – 11.3; P = .002) in favour of APM. The mean change of the groups in physical functioning according to the RAND-36 was 21.7 points after APM (95% CI, 18.0 – 25.4) and 14.9 points after PT (95% CI, 11.2 – 18.5) with an MD between the groups of 6.8 points (95% CI 1.7 – 12.1; P = .018). APM scored significantly better on patient specific complaints (P = .009) and bodily pain (P = .028). No differences were seen in general health, vitality, role limitations, quality of life and level of activities. In the repeated measures analysis of variance, the variable “time” had an effect size (ES) of .396 (P = ,000), and the variable “treatment group” an ES of .000 (P = ,984) on IKDC scores. In the generalized estimating equations analysis with IKDC score as dependent variable, the variable “baseline IKDC score” had a B value of 0.385 (95% Wald BI, 0.3 – 0.5; P = .000), the variable “baseline pain at rest (VAS)” a B value of -0.08 (95% Wald BI, -0.2 – 0.0; P = .039) and the variable “BMI” a B value of -0.662 (95% Wald BI, -0.2 – 8.7; P = .003). There was no significant effect of treatment. CONCLUSION - In older patients with non-obstructive meniscal tears, PT was not inferior to APM after one year follow-up. BMI, physical functioning and pain at rest prior to treatment proved to have lasting influence on physical functioning after treatment, whereas the followed treatment itself did not have a direct effect on physical functioning.

Item Type:	Thesis (Thesis)
Supervisor name:	Bulstra, Prof. dr. S.K. and Orthopedisch chirurg en opleider, UMCG
Supervisor name:	Poolman, Dr. R.W and Orthopedisch chirurg en opleider, OLVG and Graaf Drs. V.A. van dePhD candidate, AIOS Orthopedie
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:07
Last Modified:	25 Jun 2020 11:07
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2712

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