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136 Meniscal surgery or exercise therapy in alleviating patient-reported mechanical symptoms in young adults with a meniscal tear
  1. Camma Damsted1,2,
  2. Jonas Bloch Thorlund1,7,
  3. Per Hölmich3,
  4. Martin Lind4,
  5. Claus Varnum5,
  6. Mogens Strange Hansen6,
  7. Søren Thorgaard Skou1,2
  1. 1Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark., Denmark
  2. 2The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark, Region Zealand, Slagelse, Denmark, Denmark
  3. 3Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark, Denmark
  4. 4Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark, Denmark
  5. 5Department of Orthopaedic Surgery, Lillebælt Hospital Vejle, Vejle, Denmark, Denmark
  6. 6Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark, Denmark
  7. 7Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark., Denmark


Introduction A common treatment strategy to alleviate mechanical symptoms in young patients with meniscal tears is meniscal surgery, however, it is unknown whether this is superior to a non-surgical strategy. Therefore, we aimed to compare meniscal surgery to early exercise therapy and patient education.

Materials and Methods In the DREAM trial 121 patients aged 18–40 were randomized to surgery (partial meniscectomy or meniscal repair) or 12-weeks of supervised exercise therapy and patient education, with the option of later surgery if needed. In this secondary analysis we included patients with self-reported mechanical symptoms (yes/no) at baseline. Patients were followed for 12 months and assessed for the presence of mechanical symptoms at 3, 6 and 12 months.

Results In total, 63/121 patients reported mechanical symptoms at baseline (surgery, n=33 and exercise, n=30), while 9/26 in the surgery group and 20/29 in the exercise group reported mechanical symptoms at 12-month (missing data on 8 patients). During follow-up 8 patients crossed over from the exercise group to use the opportunity for later surgery.

At 12-month the risk difference was 34.4% (95% CI 9.5–59.2) and the relative risk was 1.99 (95%CI, 1.11–3.57) in favour of the surgery group. Similarly, a larger proportion of patients in the exercise group reported mechanical symptoms at 3 and 6 months.

Conclusion Our results suggest that meniscal surgery may be superior in alleviating mechanical symptoms compared with exercise therapy and patient education with the option of later surgery in young patients with meniscal tears and self-reported mechanical symptoms.

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