Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial

Noorduyn JCA, van de Graaf VA, Willigenburg NW, Scholten-Peeters GGM, Kret EJ, van Dijk RA, Buchbinder R, Hawker GA, Coppieters MW, Poolman RW · JAMA Network Open

IKDC knee function improved 29.6 points (SD 18.7) after surgery and 25.1 (SD 17.8) after physical therapy over five years, a crude between-group difference of 3.5 points (95% CI 0.7 to 6.3) against a pre-specified noninferiority threshold of 11 points, so physical therapy remained noninferior. Radiographic osteoarthritis progressed at comparable rates in the two arms. During follow-up 52 of 162 in the physical-therapy group (32.1%) had a delayed meniscectomy, 44 of them within the first two years.

Population

321 patients aged 45 to 70 with a degenerative meniscal tear, in nine Dutch hospitals; 278 (87.1%) completed 5 years

Intervention

Arthroscopic partial meniscectomy

Comparator

16 sessions of exercise-based physical therapy

Limitations

A noninferiority design answers whether physical therapy is not much worse, not whether either works; there is no placebo or no-treatment arm. Open-label, and a third of the physical-therapy arm had surgery anyway.