Meniscal tears are frequent sources of disability, especially in persons with concomitant knee osteoarthritis (OA). Observational studies suggest that while arthroscopic partial meniscectomy (APM) consistently relieves symptoms and improves functional status in patients with symptomatic meniscal tear, the outcome of APM is decidedly worse in patients with coexisting OA. There has never been a clinical trial of the effectiveness of APM in patients with knee OA and concomitant symptomatic meniscal tear. Further, there is little evidence on the efficacy of nonoperative management in this setting. Thus, clinicians are uncertain about the short and long term benefits, drawbacks and indications for APM in OA patients with symptomatic meniscal tears. We propose a multicenter, randomized controlled trial of APM versus a standardized nonoperative program in patients with symptomatic meniscal tear and concomitant knee OA. The trial will be carried out in five outstanding centers. The study has three specific aims:
Aim 1 : To conduct a randomized controlled trial to compare the efficacy of APM versus a standardized non-operative management program among patients with symptomatic meniscal tear and knee OA.
Aim 2 : To follow the trial cohort for two years in order to determine whether differences between APM and nonoperative therapy in pain relief and functional improvement persist for two years.
Aim 3 : To evaluate the cost-effectiveness of APM in the management of patients with symptomatic meniscal tears in the setting of knee osteoarthritis. The trial will provide an evidence-based framework for effective and cost-effective clinical management of meniscal tears in the setting of knee OA, one of the most common clinical dilemmas affecting a large proportion of middle-aged and older persons in the US.Public Health Summary: Over 700,000 surgeries are performed each year for patients who have symptoms of a meniscal tear and who also have knee osteoarthritis. Presently, clinicians do not know whether this operation is better than nonoperative therapy. We propose a multicenter randomized controlled trial to rigorously compare these two approaches.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR055557-05
Application #
8118974
Study Section
Special Emphasis Panel (ZAR1-MLB-G (O2))
Program Officer
Panagis, James S
Project Start
2007-09-21
Project End
2012-07-31
Budget Start
2011-08-01
Budget End
2012-07-31
Support Year
5
Fiscal Year
2011
Total Cost
$662,081
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
MacFarlane, L A; Yang, H; Collins, J E et al. (2017) Associations among meniscal damage, meniscal symptoms and knee pain severity. Osteoarthritis Cartilage 25:850-857
Tuakli-Wosornu, Yetsa A; Selzer, Faith; Losina, Elena et al. (2016) Predictors of Exercise Adherence in Patients With Meniscal Tear and Osteoarthritis. Arch Phys Med Rehabil 97:1945-1952
Katz, Jeffrey N; Wright, John; Spindler, Kurt P et al. (2016) Predictors and Outcomes of Crossover to Surgery from Physical Therapy for Meniscal Tear and Osteoarthritis: A Randomized Trial Comparing Physical Therapy and Surgery. J Bone Joint Surg Am 98:1890-1896
Losina, Elena; Dervan, Elizabeth E; Paltiel, A David et al. (2015) Defining the Value of Future Research to Identify the Preferred Treatment of Meniscal Tear in the Presence of Knee Osteoarthritis. PLoS One 10:e0130256
Katz, Jeffrey N; Brownlee, Sarah A; Jones, Morgan H (2014) The role of arthroscopy in the management of knee osteoarthritis. Best Pract Res Clin Rheumatol 28:143-56
Katz, J N; Losina, E (2014) Arthroscopic partial meniscectomy for degenerative tears: where do we stand? Osteoarthritis Cartilage 22:1749-51
Katz, Jeffrey N; Brophy, Robert H; Chaisson, Christine E et al. (2013) Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 368:1675-84
Katz, Jeffrey N; Chaisson, Christine E; Cole, Brian et al. (2012) The MeTeOR trial (Meniscal Tear in Osteoarthritis Research): rationale and design features. Contemp Clin Trials 33:1189-96
Niu, Nina N; Losina, Elena; Martin, Scott D et al. (2011) Development and preliminary validation of a meniscal symptom index. Arthritis Care Res (Hoboken) 63:208-15
Katz, Jeffrey N; Wright, John; Levy, Bruce A et al. (2011) Departures from community equipoise may lead to incorrect inference in randomized trials. J Clin Epidemiol 64:280-5

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