38 Meniscal surgery or exercise therapy for young adults with meniscal tears: long-term follow-up and osteoarthritis development in the DREAM trial

Introduction Previously, we found similar 2-year improvements in patient-reported outcomes for young patients with meniscal tears randomized to early surgery or exercise therapy (with optional delayed surgery). Here we aimed to compare patient-reported outcomes, relief of mechanical symptoms and development of osteoarthritis (OA) at 6–8 years follow-up by online questionnaire.Materials and Methods We included adults aged 18–40 years with an MRI-verified meniscal tear from the Danish RCT on Exercise versus Arthroscopic Meniscal surgery (DREAM trial). Primary outcome was the between-group difference in change in the Knee injury and Osteoarthritis Outcome Score (KOOS4: mean of pain, symptoms, sport/recreation, and quality-of-life subscales) from baseline to 6–8 years follow-up. We also compared relief of mechanical symptoms, and self-reported physician-diagnosed osteoarthritis at 6–8 years.Results In total, 76/121 (62%) participants completed the follow-up (35 surgery, 41 exercise). Mean (95% CI) improvements in KOOS4 were 18.7 (13.3, 24.0) for surgery and 23.2 (17.7, 28.7) for exercise; adjusted mean difference 4.4 (-3.0, 11.9) at 6–8 years. Mechanical symptoms seemed more likely to persist in the exercise group (relative risk at any time point 1.67, 95% CI 0.94, 2.40), and OA seemed more prevalent in the surgery group (8.5% vs 4.8%, OR 2.29, 95% CI 0.33, 15.6).Conclusion Early surgery was not superior to exercise and education with optional delayed surgery for improving patient-reported outcomes at 6–8 years. OA was more prevalent in the surgery group, and mechanical symptoms were more likely to persist in the exercise group, though differences were not statistically significant.