6/28/23, 1:19 AM DREAM Pathway Feedback Search Clinical Topics Home Studies DREAM DREAM Trial question Is early surgery superior to a strategy of exercise and education in young adults with meniscal tear? Study design Multi-center Open label RCT Population Characteristics of study participants 28.0% female N = 121 72.0% male 121 patients (34 female, 87 male) Inclusion criteria: young adults with MRI-verified meniscal tears Key exclusion criteria: previous surgery on the affected knee; clinical suspicion of displaced bucket-handle tear confirmed by MRI; fracture of the affected extremity within the previous 12 months; complete rupture of 1 knee ligaments Interventions N=60 early surgery (partial meniscectomy or meniscal repair) N=61 exercise and education (12-week supervised exercise therapy and education with the option of surgery later if needed) Primary outcome Improvement in Knee Injury and Osteoarthritis Outcome Score at 12 months 19.2 19.2 16.4 14.4 9.6 4.8 https://web.pathway.md/studies/rectWKLo1sEx5NdZS 1/2 6/28/23, 1:19 AM DREAM Pathway No significant difference 0.0 Early surgery Exercise and education No significant difference in improvement in Knee Injury and OA Outcome Score at 12 months (19.2 vs. 16.4; aMD 5.4, 95% CI -0.7 to 11.4) Secondary outcomes No significant difference in improvement in pain subscale of Knee Injury and OA Outcome Score at 12 months (15.1 vs. 13.3; aMD 6, 95% CI 0.4 to 11.7) Borderline significant increase in improvement in Western Ontario Meniscal Evaluation Tool score at 12 months (24 vs. 18.8; aMD 9.4, 95% CI 1.7 to 17) Borderline significant decrease in improvement in isometric lower extremity muscle strength at 12 months (1.75 kg vs. 29.1 kg; aMD -24.4, 95% CI -39.6 to -8.7) Safety outcomes No significant difference in serious adverse events and non-serious adverse events. Conclusion In young adults with MRI-verified meniscal tears, early surgery was not superior to exercise and education with respect to improvement in Knee Injury and OA Outcome Score at 12 months. Reference S ren T. Skou, Ph.D., Per H lmich et al. Early Surgery or Exercise and Education for Meniscal Tears in Young Adults. NEJM Evid. 2022;1(2). Open reference URL https://web.pathway.md/studies/rectWKLo1sEx5NdZS 2/2