Background/Purpose: Patients who present with a symptomatic knee that has both osteoarthritis and a meniscal tear present a difficult treatment challenge. They may be treated nonoperatively or with arthroscopic partial meniscectomy (APM); there is limited data on the comparative outcomes of these treatments.

Methods: We conducted a randomized controlled trial in 7 US centers involving 351 subjects > 45 years old with symptomatic meniscal tear and osteoarthritic cartilage change, documented by magnetic resonance imaging (MRI). To be eligible, subjects must have exhibited meniscus related symptoms for at least 4 weeks. Enrolled subjects were randomized to APM with postoperative physical therapy (APM arm) or to nonoperative care including a standardized PT regimen focused on strengthening (non-operative arm).  The primary analysis compared change in functional status (WOMAC) over 6 months across the 2 arms, using an intention to treat (ITT) approach.  A secondary outcome was a binary variable defined as lack of improvement in WOMAC function of at least 8 points over 6 months (a clinically relevant change) OR unplanned cross-over (from nonoperative therapy to APM or from APM to nonoperative therapy). We carried 3 month observations forward to address missing 6 month outcome data.

Results: 174 subjects were randomized to APM and 177 to the nonoperative arm. The arms were balanced with respect to baseline function, radiographic severity, age and sex. The response rate at 6 months was 84% across both arms. In the ITT analysis, mean improvement in WOMAC function after 6 months was 19.4 points (sd 18.4) in subjects randomized to APM and 16.8 (sd 18.1) in those randomized to the nonoperative arm (p=0.19). Of the 174 randomized to APM, 9 (5%) did not receive surgery by 6 months. Of the 177 subjects randomized to the non-operative arm, 53 (30%) crossed over and had APM by 6 months (Table). In the analysis of the secondary outcome, 26% of subjects randomized to APM vs. 51% of subjects in the nonoperative arm either did not improve by at least 8 points on WOMAC function or crossed over (p<0.0001; Table).

Conclusion: These preliminary trial findings suggest that in both the APM and the nonoperative arms, subjects experienced substantial improvement in functional status over six months, with no significant differences between the two arms in the ITT analysis.   30% of subjects randomized to nonoperative therapy underwent APM within the first six months. As with all RCT’s the results should be generalized cautiously to clinical populations. These findings will aid physicians and their patients over 45 who present with knee symptoms in association with meniscal tears and osteoarthritis as they decide whether to elect APM or nonoperative therapy.