Glastra van Loon T1, Noorduyn JCA1,2, van de Graaf VA1, Willigenburg NW1, Butter IK1,3, Poolman RW1
1OLVG, Orthopaedics, JointResearch, Amsterdam, Netherlands, 2OLVG, Physiotherapy, Amsterdam, Netherlands, 3OLVG, Leerhuis, Amsterdam, Netherlands
Background: In middle-aged and older patients with a meniscal tear, superiority of arthroscopic partial meniscectomy (APM) over physical therapy (PT) is not proven. Nevertheless, surgery is still widely performed and patients are overoptimistic about their recovery. The majority (>70%) of APMs is performed in patients over 40 years old and the incidence of APM in this population has barely declined over the past years. Primary outcomes of previous randomized controlled trials evaluated the patients' perception of general knee symptoms, knee function and quality of life. However, focusing on specific activities that the individual patient values most can enhance the patients' treatment participation and satisfaction. To the authors' knowledge, no previous studies have compared intervention effects in patients with meniscal tears, focusing on patient-specific activities.
Purpose: To evaluate the effectiveness of arthroscopic partial meniscectomy compared with physical therapy in middle aged and older patients with a meniscal tear in terms of patient-specific activities.
Methods: Data were retrieved from a multicentre non-inferiority randomized controlled trial, comparing APM with PT in patients with a non-obstructive meniscal tear, the ESCAPE trial. Physical activity levels were evaluated using the Patient-Specific Complaint (PSC) questionnaire, as recommended by the Dutch physiotherapy association (KNGF). The questionnaire was administered at 0, 3, 6, 12, and 24 months. Patients selected their three most important activities from a list of 28 and rated the experienced difficulty for each activity on a numeric rating scale from 0 (no difficulty) to 10 (impossible to perform).
The selected activities were qualitatively analyzed using descriptive statistics. PSC scores were calculated as the mean difficulty scores of the three activities per patient. The overall difference between treatment groups was analyzed using linear mixed modelling with adjustment for possible confounders, using an intention-to-treat approach.
Results: Between 2013 and 2015, 321 patients were included and randomly allocated to APM (n=159) or PT (n=162). At the 24 months follow-up, 286 patients (APM=139, PT=147) completed the PSC, resulting in a response rate of 89%.
The most frequently chosen activities in both groups were: sports, walking , running, and standing for a long time. Both groups had a mean PSC score of 6.7 at baseline and improved significantly over the 24 month follow-up period (APMΔ= 4.8; PTΔ= 3.9 points). Moreover, mixed modeling analysis revealed a significant overall difference between groups of 0.81 points on the PSC in favor of APM (p 0.001).
Conclusion(s): This study is the first to evaluate treatment effect for meniscal tears based on patient specific activities using the PSC questionnaire. We found a statistically significant difference between APM and PT. To our knowledge, the smallest detectable change and minimal clinically important difference of the PSC in this population is unknown. However, it seems unlikely that the small difference ( 1 point) between APM and PT is clinically relevant. Therefore we conclude that PT is a good alternative for APM regarding the treatment of meniscal tears, based on patient-specific activities.
Implications: This study contributes to the healthcare evaluation of meniscal tear treatment, provoking a shift towards conservative treatment (e.g. physical therapy) in this population.
Keywords: Meniscal tears, Treatment, PSC questionnaire
Funding acknowledgements: The Netherlands Organization for Health Research and Development (ZonMw)
Zilverenkruis Health Insurance
OLVG research foundation
Purpose: To evaluate the effectiveness of arthroscopic partial meniscectomy compared with physical therapy in middle aged and older patients with a meniscal tear in terms of patient-specific activities.
Methods: Data were retrieved from a multicentre non-inferiority randomized controlled trial, comparing APM with PT in patients with a non-obstructive meniscal tear, the ESCAPE trial. Physical activity levels were evaluated using the Patient-Specific Complaint (PSC) questionnaire, as recommended by the Dutch physiotherapy association (KNGF). The questionnaire was administered at 0, 3, 6, 12, and 24 months. Patients selected their three most important activities from a list of 28 and rated the experienced difficulty for each activity on a numeric rating scale from 0 (no difficulty) to 10 (impossible to perform).
The selected activities were qualitatively analyzed using descriptive statistics. PSC scores were calculated as the mean difficulty scores of the three activities per patient. The overall difference between treatment groups was analyzed using linear mixed modelling with adjustment for possible confounders, using an intention-to-treat approach.
Results: Between 2013 and 2015, 321 patients were included and randomly allocated to APM (n=159) or PT (n=162). At the 24 months follow-up, 286 patients (APM=139, PT=147) completed the PSC, resulting in a response rate of 89%.
The most frequently chosen activities in both groups were: sports, walking , running, and standing for a long time. Both groups had a mean PSC score of 6.7 at baseline and improved significantly over the 24 month follow-up period (APMΔ= 4.8; PTΔ= 3.9 points). Moreover, mixed modeling analysis revealed a significant overall difference between groups of 0.81 points on the PSC in favor of APM (p 0.001).
Conclusion(s): This study is the first to evaluate treatment effect for meniscal tears based on patient specific activities using the PSC questionnaire. We found a statistically significant difference between APM and PT. To our knowledge, the smallest detectable change and minimal clinically important difference of the PSC in this population is unknown. However, it seems unlikely that the small difference ( 1 point) between APM and PT is clinically relevant. Therefore we conclude that PT is a good alternative for APM regarding the treatment of meniscal tears, based on patient-specific activities.
Implications: This study contributes to the healthcare evaluation of meniscal tear treatment, provoking a shift towards conservative treatment (e.g. physical therapy) in this population.
Keywords: Meniscal tears, Treatment, PSC questionnaire
Funding acknowledgements: The Netherlands Organization for Health Research and Development (ZonMw)
Zilverenkruis Health Insurance
OLVG research foundation
Topic: Musculoskeletal: lower limb; Orthopaedics; Outcome measurement
Ethics approval required: Yes
Institution: OLVG
Ethics committee: VCMO/MEC-U
Ethics number: NL44188.100.13
All authors, affiliations and abstracts have been published as submitted.
