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New funding announced by the Federal Government will see researchers from the Kolling Institute and the University of Sydney drive an international study to determine the best treatment for those with knee cartilage damage.

More than $1 million dollars has been awarded through a collaborative research grant scheme involving Australia’s National Health and Medical Research Council and the National Institute for Health Research in the United Kingdom.

Professor Manuela Ferreira from the University of Sydney’s Faculty of Medicine and Health and the Kolling Institute welcomed the announcement, saying the project will compare the outcomes of two approaches to rehabilitation and pain relief for people who have had their meniscus cartilage removed from their knee.

The five-year study will determine the clinical and cost effectiveness of meniscus transplant surgery compared with non-surgical treatment of exercise and physiotherapy.

Professor Manuela Ferreira said there is a significant need for this research with meniscal damage one of the most common knee injuries, affecting a large share of the community.

“Degenerative meniscal damage is more common in the older population while acute traumatic tears predominantly occur in the younger population due to sporting injuries,” she said.

“Regardless of how the damage is caused, it can lead to symptoms such as pain, stiffness and locking of the knee which can be debilitating.

“The current treatments are determined by the extent of the damage. A small tear to the

meniscus can be repaired with surgery, but generally the damage requires partial or total removal of the meniscus with a meniscectomy.

“These treatments are often effective at relieving the symptoms of meniscal damage, but they leave the patient with a meniscal deficiency which will often lead to further knee damage, such as osteoarthritis.”

There is increasing evidence demonstrating the effectiveness of meniscus transplant surgery, known as a meniscal allograft transplant, where a donor meniscus is inserted into the knee to reduce pain and improve function.

The technique is currently being performed at some centres in Australia and the United Kingdom, yet there are few randomised trials or large scale studies supporting the use of the procedure.

“Our study will comprehensively examine the clinical and cost-effectiveness of the technique, providing robust data to inform clinical practice and establish the best treatment strategy,” Professor Ferreira said.

“If the meniscus transplant surgery proves effective, it may reduce pain and improve quality of life for many people.

“However, if it is not clinically or cost effective, the results will halt the widespread use of an expensive intervention.

“The study also represents an excellent opportunity to work with collaborators from the United Kingdom to tackle a shared health challenge.

“The project will bring researchers from our two countries together to solve an important health issue and improve health outcomes across both countries.”

More than 140 participants are set to be involved across the two sites in Australia and the UK.

Kolling researcher Professor Lyn March will lead a large, collaborative national trial to improve treatments and outcomes for those with disabling rheumatoid and psoriatic arthritis.

Federal Government MRFF funding will see more than $2.7 million invested in the project which will involve 400 participants across the country.

Professor March, who is also the head of the Department of Rheumatology at Royal North Shore Hospital, has welcomed the funding saying there’s a need for more robust evidence around existing treatment approaches.

“Rheumatoid and psoriatic arthritis are autoimmune musculoskeletal diseases that can cause severe pain, joint destruction, disability and early death,” Professor March said.

“Sadly there is no cure and while some people are able to achieve drug-free remission, the diseases often reoccur.”

Existing treatments include the biologic disease modifying antirheumatic drugs, which suppress the overactive immune system. These medications have successfully improved people’s quality of life, but they come with risks of significant side effects, including serious infections.

“Ideally, we would like to bring people off these medications when their symptoms subside, but there are no clear guidelines around the best time to do that, or how these therapies can be reduced and stopped,” she said.

“Our study will aim to identify the optimal medication approaches towards achieving and maintaining drug free remission in as many patients as possible. Importantly, we’ll be looking to confirm the safest, most effective and most economical treatment strategies.”

Professor March said this is an important national trial which will involve prominent rheumatology clinician researchers, leading scientists, economists and post-doctoral researchers from universities and hospitals across Australia.

“We will also partner with the Australia and New Zealand Musculoskeletal Clinical Trials Network, the national Australian Arthritis and Autoimmune Biobank Collaborative (A3BC) registry/biobank network, and leading professional and consumer bodies.”

“Importantly, the national infrastructure of the A3BC will allow us to generate new knowledge on rheumatoid and psoriatic arthritis through the trial and also optimise the Government’s return on investment by following participants long-term as a clinical registry/biobank cohort.”

“The trial represents a wonderful collaborative opportunity to assist those with rheumatoid and psoriatic arthritis manage their condition in the safest and most effective way. This will deliver long term health and economic benefits to individuals and the broader community.”

The trial will be open to any Australian adult living with rheumatoid and psoriatic arthritis, providing they meet the criteria and have the disease well-controlled with a biologic medication.

Recruitment is anticipated to begin later this year.