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.