Background:Short- and midterm evaluations of arthroscopic meniscal surgery have shown little or no effect in favor of surgery, although long-term effects, including radiographic changes, are unknown.Purpose:To compare the 10-year outcomes in middle-aged patients with meniscal symptoms between a group that received an exercise program alone and a group that received knee arthroscopy in addition to the exercise program with respect to the prevalence of radiographic and symptomatic osteoarthritis (OA), patient-reported outcomes, and clinical status.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Of 179 eligible patients aged 45 to 64 years, 150 were randomized to undergo either 3 months of exercise therapy (nonsurgery group) or knee arthroscopy in addition to the exercise therapy (surgery group). Surgery usually consisted of partial meniscectomy (n = 56) or diagnostic arthroscopy (n = 8). Radiographs were assessed according to the Kellgren-Lawrence score at the baseline and 5- and 10-year follow-ups. Patient-reported outcome measures were reported at the baseline and 1-, 3-, 5-, and 10-year follow-ups. Clinical status was assessed at a 10-year follow-up. The primary outcomes were radiographic OA and changes in the Knee injury and Osteoarthritis Outcome Score Pain subscale (KOOSPAIN) from the baseline to the 10-year follow-up. The primary analysis was performed using the intention-to-treat approach.Results:At the time of the 10-year follow-up, eight patients had died, leaving 142 eligible patients. Radiographic OA was assessed for 95 patients (67%), questionnaires were answered by 110 (77%), and the clinical status was evaluated for 95 (67%). Radiographic OA was present in 67% of the patients in each group ( P≥ .999); symptomatic OA was present in 47% of the nonsurgery group and 57% of the surgery group ( P = .301). There were no differences between groups regarding changes from baseline to 10 years in any of the KOOS subscales.Conclusion:Knee arthroscopic surgery, in most cases consisting of partial meniscectomy or diagnostic arthroscopy, in addition to exercise therapy in middle-aged patients with meniscal symptoms, did not increase the rates of radiographic or symptomatic OA and resulted in similar patient-reported outcomes at the 10-year follow-up compared with exercise therapy alone. Considering the short-term benefit and no long-term harm from knee arthroscopic surgery, the treatment may be recommended when first-line treatment—including exercise therapy for ≥3 months—does not relieve patient’s symptoms.Registration:Clinical Trials NCT01288768 (ClinicalTrials.gov identifier).

中文翻译：

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有半月板症状的中年患者进行膝关节镜手术：一项前瞻性、随机对照试验的 10 年随访


背景：关节镜半月板手术的短期和中期评估显示，尽管长期影响（包括影像学变化）尚不清楚，但对手术的影响很小或没有。目的：比较中年患者与半月板手术的 10 年结果单独接受运动计划的组和除运动计划外还接受膝关节镜检查的组之间的半月板症状，与放射学和症状性骨关节炎 (OA) 的患病率、患者报告的结果和临床状态有关。 研究设计：随机对照试验；证据级别，1.方法：在 179 名年龄在 45 至 64 岁之间的符合条件的患者中，150 名患者被随机分配接受 3 个月的运动治疗（非手术组）或除运动治疗外还接受膝关节镜检查（手术组）。手术通常包括部分半月板切除术 (n = 56) 或诊断性关节镜检查 (n = 8)。根据基线以及 5 年和 10 年随访时的 Kellgren-Lawrence 评分对 X 光片进行评估。患者报告的结果测量在基线和 1 年、3 年、5 年和 10 年随访时报告。临床状态在 10 年随访时进行评估。主要结果是放射学 OA 以及膝关节损伤和骨关节炎结果评分疼痛分量表 (KOOS) 的变化疼痛）从基线到 10 年随访。主要分析采用意向治疗方法进行。结果：在 10 年随访时，8 名患者死亡，剩下 142 名符合条件的患者。对 95 名患者 (67%) 进行了放射学 OA 评估，110 名患者 (77%) 回答了问卷，对 95 名患者 (67%) 进行了临床状态评估。每组中 67% 的患者存在放射学 OA（P≥.999）； 47% 的非手术组和 57% 的手术组存在症状性 OA ( P = .301)。任何 KOOS 分量表从基线到 10 年的变化在各组之间均无差异。结论：对于有半月板症状的中年患者，除了运动疗法外，大多数情况下膝关节镜手术还包括部分半月板切除术或诊断性关节镜检查。 ，与单独的运动疗法相比，并没有增加放射学或症状性 OA 的发生率，并且在 10 年随访中产生了类似的患者报告结果。考虑到膝关节镜手术的短期益处和无长期危害，当一线治疗（包括≥3个月的运动疗法）不能缓解患者症状时，可以推荐该治疗。注册：临床试验NCT01288768（ClinicalTrials.政府标识符）。