ESCAPE

Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial.

van de Graaf VA, Noorduyn JCA, Willigenburg NW, et al. JAMA 2018 · PMID 30285177 · doi:10.1001/jama.2018.13308

Question

In patients aged 45-70 with a non-obstructive meniscal tear, is physiotherapy non-inferior to arthroscopic partial meniscectomy?

Design

Multicentre non-inferiority RCT in the Netherlands with 24-month follow-up.

Patients

321 patients aged 45-70 with a symptomatic non-obstructive meniscal tear (no locking).

Intervention

Structured physical therapy programme

Comparison

Early arthroscopic partial meniscectomy

Primary outcome

IKDC subjective knee function score over 24 months

Key result

Physical therapy was non-inferior to arthroscopic partial meniscectomy for patient-reported knee function over 24 months. Some physiotherapy patients crossed over to surgery for persistent symptoms.

Limitations

Unblinded design and crossover to surgery; non-inferiority margin choice is open to debate.

Impact on practice

Supports physiotherapy as first-line treatment for non-obstructive degenerative meniscal tears in middle-aged and older patients, with surgery reserved for those who fail it.