Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults—An Exploratory Analysis From the DREAM Trial

Camma Damsted; Søren T. Skou; Per Hölmich; Martin Lind; Claus Varnum; Hans Peter Jensen; Mogens Strange Hansen; Jonas Bloch Thorlund

doi:10.2519/jospt.2024.12245

Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults—An Exploratory Analysis From the DREAM Trial

Camma Damsted, Søren T. Skou, Per Hölmich, Martin Lind, Claus Varnum, Hans Peter Jensen, Mogens Strange Hansen, Jonas Bloch Thorlund^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

OBJECTIVE: To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. t DESIGN: Randomized controlled trial. t METHODS: In a randomized controlled trial (the “Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults” [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging–verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS₄) covering pain, symptoms, function in sport and recreation, and quality of life. t RESULTS: Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS₄ after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). t CONCLUSION: In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings.

Original language	English
Journal	Journal of Orthopaedic and Sports Physical Therapy
Volume	54
Issue	5
Pages (from-to)	340-349
Number of pages	10
ISSN	0190-6011
DOIs	https://doi.org/10.2519/jospt.2024.12245
Publication status	Published - May 2024

Keywords

knee
meniscal tears
symptom onset
traumatic
treatment

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10.2519/jospt.2024.12245

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Damsted, C., Skou, S. T., Hölmich, P., Lind, M., Varnum, C., Jensen, H. P., Hansen, M. S., & Thorlund, J. B. (2024). Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults—An Exploratory Analysis From the DREAM Trial. Journal of Orthopaedic and Sports Physical Therapy, 54(5), 340-349. https://doi.org/10.2519/jospt.2024.12245

@article{c2df6ee31a7c43e981ce72122fd6c347,

title = "Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults—An Exploratory Analysis From the DREAM Trial",

abstract = "OBJECTIVE: To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. t DESIGN: Randomized controlled trial. t METHODS: In a randomized controlled trial (the “Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults” [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging–verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS4) covering pain, symptoms, function in sport and recreation, and quality of life. t RESULTS: Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS4 after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). t CONCLUSION: In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings.",

keywords = "knee, meniscal tears, symptom onset, traumatic, treatment",

author = "Camma Damsted and Skou, {S{\o}ren T.} and Per H{\"o}lmich and Martin Lind and Claus Varnum and Jensen, {Hans Peter} and Hansen, {Mogens Strange} and Thorlund, {Jonas Bloch}",

note = "Publisher Copyright: {\textcopyright} 2024 JOSPT{\textregistered}, Inc.",

year = "2024",

month = may,

doi = "10.2519/jospt.2024.12245",

language = "English",

volume = "54",

pages = "340--349",

journal = "Journal of Orthopaedic and Sports Physical Therapy",

issn = "0190-6011",

publisher = "American Physical Therapy Association Orthopaedic and Sports Physical Therapy Sections",

number = "5",

}

Damsted, C, Skou, ST, Hölmich, P, Lind, M, Varnum, C, Jensen, HP, Hansen, MS & Thorlund, JB 2024, 'Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults—An Exploratory Analysis From the DREAM Trial', Journal of Orthopaedic and Sports Physical Therapy, vol. 54, no. 5, pp. 340-349. https://doi.org/10.2519/jospt.2024.12245

Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults—An Exploratory Analysis From the DREAM Trial. / Damsted, Camma; Skou, Søren T.; Hölmich, Per et al.
In: Journal of Orthopaedic and Sports Physical Therapy, Vol. 54, No. 5, 05.2024, p. 340-349.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults—An Exploratory Analysis From the DREAM Trial

AU - Damsted, Camma

AU - Skou, Søren T.

AU - Hölmich, Per

AU - Lind, Martin

AU - Varnum, Claus

AU - Jensen, Hans Peter

AU - Hansen, Mogens Strange

AU - Thorlund, Jonas Bloch

PY - 2024/5

Y1 - 2024/5

N2 - OBJECTIVE: To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. t DESIGN: Randomized controlled trial. t METHODS: In a randomized controlled trial (the “Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults” [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging–verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS4) covering pain, symptoms, function in sport and recreation, and quality of life. t RESULTS: Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS4 after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). t CONCLUSION: In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings.

AB - OBJECTIVE: To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. t DESIGN: Randomized controlled trial. t METHODS: In a randomized controlled trial (the “Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults” [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging–verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS4) covering pain, symptoms, function in sport and recreation, and quality of life. t RESULTS: Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS4 after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). t CONCLUSION: In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings.

KW - knee

KW - meniscal tears

KW - symptom onset

KW - traumatic

KW - treatment

U2 - 10.2519/jospt.2024.12245

DO - 10.2519/jospt.2024.12245

M3 - Journal article

C2 - 38385220

AN - SCOPUS:85191897038

SN - 0190-6011

VL - 54

SP - 340

EP - 349

JO - Journal of Orthopaedic and Sports Physical Therapy

JF - Journal of Orthopaedic and Sports Physical Therapy

IS - 5

ER -

Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults—An Exploratory Analysis From the DREAM Trial

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Keywords

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