Abstract：
OBJECTIVE: To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. DESIGN: Randomized controlled trial. METHODS: In a randomized controlled trial (the \"Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults\" [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging-verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS4) covering pain, symptoms, function in sport and recreation, and quality of life. RESULTS: Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS4 after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). CONCLUSION: In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 22 February 2024. doi:10.2519/jospt.2024.12245.
摘要：
目的：比较早期半月板手术与运动和教育与后期手术的选择对疼痛的影响。函数,以及年轻半月板撕裂患者的生活质量，考虑到症状发作。设计和方法：在一项随机对照试验（DREAM试验）中，121名年龄在18-40岁的MRI证实的半月板撕裂患者被随机接受手术或12周的监督运动和患者教育。对于这项探索性研究，分析按症状发作(创伤性/非创伤性)进行分层.主要结局是12个月后四个膝关节损伤和骨关节炎结局评分（KOOS4）分量表的平均评分变化差异，包括疼痛，症状,在运动和娱乐和生活质量方面的功能。结果：运动治疗组42例（69％）和手术组47例（78％）被归类为创伤性撕裂。我们观察到两个治疗组的创伤性眼泪在12个月后KOOS4的变化没有差异（18.8vs.16.0在手术中与运动治疗组；调整后的平均差，4.8[95%置信区间，-1.7至11.2]）或非创伤性眼泪（20.6vs.17.3在手术中与运动治疗组；调整后的平均差，7.0[95%置信区间，-3.7至17.7])。结论：在创伤性和非创伤性半月板撕裂患者中，早期半月板手术在改善疼痛方面似乎并不优于运动和教育，函数,12个月后的生活质量。需要进一步的研究来证实这些发现的临床适用性。
