Thank you, Bruce, and thank you for the invitation to speak today on behalf of the METEOR team. Is this working? Sorry. I'm not aware of any conflicts of interest. This is the METEOR study sites and investigators, a number of whom are here in the audience today. And obviously this work was also made possible by the many clinical and research support staff at the study sites. METEOR, for those who are not familiar with it, was a prospective randomized trial of physical therapy compared to arthroscopic partial meniscectomy in patients with meniscus tears and knee osteoarthritis. It was NIH funded, and it was a registered clinical trial. As we are all familiar with, meniscus tears are very common in patients with osteoarthritis, and treatment of these tears with surgery is a very common procedure. The optimal management of meniscus tears in patients with knee OA is not well studied, although there has been a number of investigations underway since this study started in the mid-2000s. The METEOR eligibility criteria were patients over the age of 45. They had to have at least a month of symptoms with meniscal symptoms, and at least some evidence of osteoarthritis on MRI or X-ray, as well as a confirmed meniscus tear on MRI. Exclusion criteria included chronically locked knees, grade 4 osteoarthritis was excluded, as well as inflammatory arthritis, and these other exclusion criteria as well. In terms of interventions, patients were randomized to a non-operative arm with a standardized PT intervention with an emphasis on strengthening. Patients were advanced based on milestones rather than time. When possible, the PT was performed at a study site center, and there was standardized progression of medications for these patients. Patients randomized to surgery underwent arthroscopic partial meniscectomy. They could not undergo any cartilage drilling procedure, and they were not allowed to have any steroid injections. They also had a standardized post-op PT regimen, and there was standardized progression of medications for these patients as well. Primary outcome was change in functional status based on WOMAC at six months. A number of secondary outcomes included a binary variable based on WOMAC improvement and unplanned crossover, as well as KUS subscales and 12- and 24-month follow-up. A little over 350 patients were enrolled and randomized. Overall, the cohort was about 60 years of age with a mean BMI of 30, slightly more females than males were enrolled. And there was a significant amount of grade three and two arthritis with a lesser extent of grade one arthritis in patients who had normal X-rays, but MRI findings consistent with osteoarthritis. This effort has led to a number of publications. The first publication was in the New England Journal of Medicine, and this showed the results of the randomized trial, which were very similar outcomes in terms of WOMAC scores and KUS scores at three, six, and 12 months. But there was a 30% crossover from the non-operative arm to the surgical arm. In terms of successes, they were very similar, with about a 73% success rate in the PT arm, with 80% to 81% in the arthroscopy group and the group that crossed over from PT to arthroscopy. In terms of secondary analysis, there was a difference in that 76% of the arthroscopic patients had a WOMAC improvement of at least eight, compared to 54% of the non-operative, but that was really primarily due to the crossover, as 30% of patients did cross over from non-operative treatment to arthroscopic meniscectomy during the study. In terms of five-year symptom outcomes, you can see very good improvement by a one year, and it was very well sustained over the five-year study in all three groups. In terms of structural outcomes, we're starting to get those in, and we're seeing similar cartilage surface area scores over the five-year study period, but there is a significant higher rate of conversion to total knee replacement in the surgical group compared to the non-operative group. So in summary, this prospective randomized comparison of physical therapy to arthroscopic partial meniscectomy in these patients showed that they can respond well to physical therapy, although there is significant crossover to surgical treatment in this cohort. There's an evolving picture that is ongoing and coming out in terms of longer term clinical and structural outcomes, as well as predictors and subgroup analysis that we will continue to see here in the near future. Thank you very much.

METEOR study

randomized trial

meniscus tears

knee osteoarthritis

clinical trial