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Arthroscopic Partial Meniscectomy in OA: A 12-Year Follow-Up

Overview

About this study

The goals of this continuation of MeTeOR are to determine: a) whether the greater structural damage observed at five years in subjects treated with APM persists over 12 years; and b) whether structural changes observed in the first five years are associated with worse pain and function and greater TKR utilization at 12 years. We propose the following aims:

  1. Conduct a 12-year follow-up visit of MeTeOR subjects to characterize the extent of cartilage damage over 12 years and identify factors associated with OA progression. MeTeOR participants will complete questionnaires and performance tests and undergo MRI and radiographs 12 years after randomization. Our analyses of cartilage damage will account for clinical and demographic features at baseline and prognostically salient events occurring over follow-up. We hypothesize that subjects with greater baseline levels of cartilage damage and those treated with APM will experience greater cartilage damage over 12 years.
     
  2. Assess whether the extent of structural progression over the first five years post-treatment in persons with OA and meniscal tear predicts worse clinical outcomes at 12 years. We hypothesize that more rapid progression over the initial five years will be predictive of greater pain, worse functional status, worse performance test results, and higher use of TKR at 12 years, independent of clinical and demographic features ascertained over the first five years. We will also assess the extent of progression in cartilage damage that is predictive of a clinically meaningful difference in KOOS Pain scores.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria:

  • Participants with knee pain of at least four weeks duration and present with at least one mechanical symptom (e.g., clicking, popping, locking, giving way).
  • Potential subjects required to have meniscal tear confirmed by MRI and evidence of cartilage damage or osteophyte on MRI or radiograph.

Exclusion Criteria:

  • Subjects with inflammatory arthritis, prior APM, or workers’ compensation, as well as subjects with Kellgren-Lawrence (KL) Grade 4 radiographs (advanced OA).

 

 

More information

Publications

  • The present study was undertaken to evaluate changes in knee magnetic resonance imaging (MRI) findings over the course of 18 months in subjects with osteoarthritic change and meniscal tear treated with arthroscopic partial meniscectomy (APM) or nonoperatively with physical therapy (PT). Read More on PubMed
  • To determine the 5-year outcome of treatment for meniscal tear in osteoarthritis. Read More on PubMed
  • Arthroscopic partial meniscectomy (APM) is used to treat meniscal tears, although its efficacy is controversial. Read More on PubMed
  • Synovitis is a prevalent feature in patients with knee osteoarthritis (OA) and meniscal tear and is associated with pain and cartilage damage. Patient-reported swelling is also prevalent in this population. The aim of this study was to investigate the cross-sectional association between patient-reported swelling and effusion-synovitis detected by magnetic resonance imaging (MRI) in patients with OA and meniscal tear. Read More on PubMed
  • Synovitis is a feature of knee osteoarthritis (OA) and meniscal tear and has been associated with articular cartilage damage. This study was undertaken to examine the associations of baseline effusion-synovitis and changes in effusion-synovitis with changes in cartilage damage in a cohort with OA and meniscal tear. Read More on PubMed
  • Sufficient lower extremity muscle strength is necessary for performing functional tasks, and individuals with knee osteoarthritis demonstrate thigh muscle weakness compared to controls. It has been suggested that lower muscle strength is associated with a variety of clinical features including pain, mobility, and functional performance, yet these relationships have not been fully explored in patients with symptomatic meniscal tear in addition to knee osteoarthritis. Our purpose was to evaluate the associations of quadriceps and hamstrings muscle strength with structural damage and clinical features in individuals with knee osteoarthritis and symptomatic meniscal tear. Read More on PubMed
  • Arthroscopic surgery is a common treatment for knee osteoarthritis (OA), particularly for symptomatic meniscal tear. Many patients with knee OA who have arthroscopies go on to have total knee arthroplasty (TKA). Several individual studies have investigated the interval between knee arthroscopy and TKA. Our objective was to summarize published literature on the risk of TKA following knee arthroscopy, the duration between arthroscopy and TKA, and risk factors for TKA following knee arthroscopy. Read More on PubMed
  • Meniscal tears occur frequently in patients with knee osteoarthritis (OA). The aim of our study was to determine whether meniscal damage identified on magnetic resonance imaging (MRI) is associated with the severity of knee pain or the frequency of meniscal symptoms in patients with knee OA. Read More on PubMed
  • To evaluate the utility of clinical history, radiographic findings, and physical examination findings in the diagnosis of symptomatic meniscal tear (SMT) in patients over age 45 years, in whom concomitant osteoarthritis is prevalent. Read More on PubMed
  • To identify predictors of poor exercise adherence in patients with osteoarthritis (OA) and meniscal tear. Read More on PubMed
  • Arthroscopic partial meniscectomy (APM) combined with physical therapy (PT) have yielded pain relief similar to that provided by PT alone in randomized trials of subjects with a degenerative meniscal tear. However, many patients randomized to PT received APM before assessment of the primary outcome. We sought to identify factors associated with crossing over to APM and to compare pain relief between patients who had crossed over to APM and those who had been randomized to APM. Read More on PubMed
  • Our aim was to examine the association between an expert clinician's impression of symptomatic meniscal tears and subsequent MRI in the context of middle-aged and older adults with knee pain. Read More on PubMed
  • Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain. Read More on PubMed
  • This paper presents the rationale and design features of the MeTeOR Trial (Meniscal Tear in Osteoarthritis Research; Clinical Trials.gov NCT00597012). MeTeOR is an NIH-funded seven-center prospective randomized controlled trial (RCT) designed to establish the efficacy of arthroscopic partial meniscectomy combined with a standardized physical therapy program as compared with a standardized physical therapy program alone in patients with a symptomatic meniscal tear in the setting of mild to moderate knee osteoarthritic change (OA). The design and execution of a trial that compares surgery with a nonoperative treatment strategy presents distinctive challenges. The goal of this paper is to provide the clinical rationale for MeTeOR and to highlight salient design features, with particular attention to those that present clinical and methodologic challenges. Read More on PubMed

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