DREAM (meniscal tear, original research)
Trial question
Is early surgery superior to a strategy of exercise and education in young adults with meniscal tear?
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: young adult patients with MRI-verified meniscal tears.
Key exclusion criteria: previous surgery on the affected knee; clinical suspicion of displaced bucket-handle tear confirmed by MRI; fracture of the affected extremity within the previous 12 months; complete rupture of ≥ 1 knee ligaments.
Interventions
N=60 early surgery (partial meniscectomy or meniscal repair).
N=61 exercise and education (12-week supervised exercise therapy and education with the option of surgery later if needed).
Primary outcome
Improvement in Knee Injury and Osteoarthritis Outcome Score at 12 months
19.2 points
16.4 points
19.2 points
14.4 points
9.6 points
4.8 points
0.0 points
Early
surgery
Exercise and
education
No significant
difference ↔
No significant difference in improvement in Knee Injury and Osteoarthritis Outcome Score at 12 months (19.2 points vs. 16.4 points; aMD 5.4, 95% CI -0.7 to 11.4).
Secondary outcomes
No significant difference in improvement in pain subscale of Knee Injury and Osteoarthritis Outcome Score at 12 months (15.1 points vs. 13.3 points; aMD 6, 95% CI 0.4 to 11.7).
Significantly greater improvement in Western Ontario Meniscal Evaluation Tool score at 12 months (24 points vs. 18.8 points; aMD 9.4, 95% CI 1.7 to 17).
Significantly smaller improvement in isometric lower extremity muscle strength at 12 months (1.75 kg vs. 29.1 kg; aMD -24.4, 95% CI -39.6 to -8.7).
Safety outcomes
No significant difference in serious adverse events and non-serious adverse events.
Conclusion
In young adult patients with MRI-verified meniscal tears, early surgery was not superior to exercise and education with respect to improvement in Knee Injury and Osteoarthritis Outcome Score at 12 months.
Reference
Søren T Skou, Per Hölmich, Martin Lind et al. Early Surgery or Exercise and Education for Meniscal Tears in Young Adults. NEJM Evid. 2022 Feb;1(2):EVIDoa2100038.
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