DREAM (meniscal tear, exploratory analysis)
Trial question
What is the role of early meniscal surgery in patients with traumatic and nontraumatic meniscus tears?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
28.0% female
72.0% male
N = 121
121 patients (34 female, 87 male).
Inclusion criteria: adult patients aged 18-40 years with traumatic and nontraumatic meniscus tears.
Key exclusion criteria: previous surgery on the affected knee; displaced bucket-handle tear; fracture of the affected extremity within the previous 6 months; complete rupture of one or more knee ligaments; participation in supervised systematic exercise for knee problems within the last 3 months.
Interventions
N=60 meniscal surgery (arthroscopic partial meniscectomy or meniscal repair following standard procedures).
N=61 exercise therapy (supervised exercise and patient education for 12 weeks).
Primary outcome
Mean improvement in Knee injury and Osteoarthritis Outcome Score at 12 months, traumatic tears
18.8 points
16 points
18.8 points
14.1 points
9.4 points
4.7 points
0.0 points
Meniscal
surgery
Exercise
therapy
Borderline significant
increase ▲
Borderline significantly greater improvement in mean Knee injury and Osteoarthritis Outcome Score at 12 months, traumatic tears (18.8 points vs. 16 points; MD 4.8, 95% CI -1.7 to 11.2).
Secondary outcomes
Borderline significantly greater improvement in mean Knee injury and Osteoarthritis Outcome Score at 12 months, nontraumatic tears (20.6 points vs. 17.3 points; MD 7, 95% CI -3.7 to 17.7).
Significantly greater improvement in mean Western Ontario Meniscal Evaluation Tool total scores at 12 months, traumatic tears (26.3 points vs. 18.8 points; MD 10.7, 95% CI 2.6 to 18.9).
Borderline significantly greater improvement in mean Western Ontario Meniscal Evaluation Tool total scores at 12 months, nontraumatic tears (14.4 points vs. 18.9 points; MD 3.2, 95% CI -10.5 to 16.9).
Conclusion
In adult patients aged 18-40 years with traumatic and nontraumatic meniscus tears, meniscal surgery was not superior to exercise therapy with respect to mean improvement in Knee injury and Osteoarthritis Outcome Score at 12 months, traumatic tears.
Reference
Camma Damsted, Søren T Skou, Per Hölmich et al. Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-An Exploratory Analysis From the DREAM Trial. J Orthop Sports Phys Ther. 2024 May;54(5):1-10.
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