Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial

Key points

1. 01IKDC scores at 24 months were identical in both groups (78 out of 100), with a between-group difference of only 0.1 points
2. 0259% of patients assigned to physical therapy never needed surgery during the follow-up period
3. 03Both groups showed clinically meaningful improvement from baseline, but neither reached maximum IKDC scores
4. 04No significant differences were found on any secondary outcome including pain, Lysholm, WOMET, KOOS, or activity level
5. 05This is the first RCT comparing these two treatments specifically in young patients (18-45 years) with traumatic tears

How it was conducted

Design

Multicentre, open-labelled, parallel randomised controlled trial (STARR trial), superiority design

Participants

100 patients aged 18-45 years with MRI-confirmed grade 3 traumatic meniscal tear, no osteoarthritis, no ACL/PCL rupture, enrolled 2014-2018 across 8 Dutch hospitals

Groups

49 randomised to early arthroscopic partial meniscectomy; 51 to standardised physical therapy for at least 3 months with optional delayed surgery after 3 months if complaints persisted

Primary outcome

IKDC score (0-100, higher is better) at 24 months, measuring symptoms, knee function, and ability to participate in sports

Follow-up

24 months; questionnaires at 0, 3, 6, 9, 12, and 24 months; clinic visits at baseline, 12, and 24 months

What they found

• Primary outcome IKDC at 24 months: 78 (95% CI 71 to 84) in the surgery group vs 78 (95% CI 71 to 84) in the physical therapy group; between-group difference 0.1 (95% CI -7.6 to 7.7); p=0.99
• 41% of patients in the physical therapy group underwent delayed arthroscopic partial meniscectomy during follow-up (median time to surgery 5.5 months, range 3-21 months)
• 91% of all included patients completed 24-month follow-up
• KOOS Pain at 24 months: 86 (79 to 92) surgery vs 84 (77 to 90) physical therapy; difference 1.9 (95% CI -5.7 to 9.6)
• KOOS Sport at 24 months: 70 (61 to 80) surgery vs 69 (60 to 79) physical therapy; difference 0.8 (95% CI -12.5 to 14.0)
• Lysholm at 24 months: 89 (85 to 94) surgery vs 88 (84 to 93) physical therapy; difference -1.0 (95% CI -6.2 to 4.1)
• WOMET at 24 months: 72 (64 to 80) surgery vs 76 (68 to 84) physical therapy; difference -3.8 (95% CI -13.8 to 6.2)
• Satisfaction with knee function at 24 months: 72 (64 to 80) surgery vs 70 (62 to 78) physical therapy; difference 1.5 (95% CI -9.3 to 12.3)
• NRS pain at rest at 24 months: 1.2 (0.4 to 1.9) surgery vs 1.2 (0.5 to 2.0) physical therapy; difference -0.1 (95% CI -0.8 to 0.7)
• Tegner activity score at 24 months: 5.4 (4.7 to 6.1) surgery vs 5.0 (4.4 to 5.7) physical therapy; difference 0.3 (95% CI -0.6 to 1.3)

Limitations

• Sample size was reduced from 158 to 100 mid-trial, leaving the study potentially underpowered to detect smaller but still clinically relevant differences
• Patients could not be blinded to their treatment, introducing potential performance and detection bias
• Patients with strong treatment preferences were likely less willing to enrol, limiting generalisability to those with equipoise
• Time from trauma to inclusion ranged from 0 to 6 months, meaning some physical-therapy patients may have already improved before randomisation

Why it matters

For patients

Young people with a traumatic meniscal tear can reasonably start with a structured physical therapy programme rather than rushing to surgery, since most will improve and many will avoid an operation entirely.

For clinicians

This trial supports offering physical therapy as first-line treatment for young patients with isolated traumatic meniscal tears in stable, non-osteoarthritic knees, reserving surgery for those with persistent complaints after 3 months.

For readers

The assumption that surgery is always necessary for traumatic meniscal tears in young patients lacks high-quality support; a conservative-first strategy produces equivalent 2-year outcomes.