Arthroscopic partial meniscectomy versus exercise therapy for degenerative meniscal tears: 10-year follow-up of the OMEX randomised controlled trial.

Objective: To evaluate radiographic knee osteoarthritis (OA) progression, development of knee OA, patient-reported outcomes and knee muscle strength at 10-year follow-up after arthroscopic partial meniscectomy (APM) or exercise therapy for degenerative meniscal tears.
Methods: Randomised controlled trial including 140 participants, with a degenerative meniscal tear and no or minimal radiographic OA changes. Participants were randomised to either APM or 12 weeks of exercise therapy (1:1 ratio). The primary outcome was knee OA progression assessed by the Osteoarthritis Research Society International (OARSI) atlas sum score (sum of medial and lateral compartment joint space narrowing and osteophyte score). Secondary outcomes included incidence of radiographic and symptomatic knee OA, patient-reported pain and knee function and isokinetic knee muscle strength.
Results: The adjusted mean difference in change in the OARSI sum score was 0.39 (95% CI -0.19 to 0.97), with more progression in the APM group. The incidence of radiographic knee OA was 23% in the APM group and 20% in the exercise group (adjusted risk difference 3% (95% CI -13% to 19%)). No clinically relevant differences were found in patient-reported outcomes or isokinetic knee muscle strength.
Conclusion: No differences in radiographic knee OA progression and comparable rates of knee OA development were observed 10 years following APM and exercise therapy for degenerative meniscal tears. Both treatments were associated with improved patient-reported pain and knee function.
Trial Registration Number: NCT01002794.
Competing Interests: Competing interests: BB reports grants from the South-Eastern Norway Regional Health Authority, during the conduct of this study. EMR is the copyright holder of Knee injury and Osteoarthritis Outcome Score (KOOS) and several other patient-reported outcome measures, and co-founder of the Good Life with Osteoarthritis in Denmark (GLA:D), a not-for-profit initiative to implement clinical guidelines in primary care hosted by University of Southern Denmark. ME reports consultancy for Grünenthal Sweden AB. MAR is the co-founder of the AktivA (www.aktivmedartrose.no) in Norway, a not-for-profit initiative to implement evidence-based guidelines hosted by the Oslo University Hospital. All other authors declare no competing interests.
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