Intervention–Outcome Alignment for Knee Preservation in Registered Meniscus Trials: A Cross-Sectional Analysis

Meniscal preservation is central to contemporary knee care, but whether registered trials use endpoints and follow-up periods capable of evaluating tissue preservation, treatment durability, and long-term joint protection remains unclear. We assessed the alignment between intervention intent and outcome prioritization in registered meniscus trials. We conducted a cross-sectional meta-research study of interventional meniscus trials registered on ClinicalTrials.gov through July 31, 2026. Trial characteristics and all registered outcomes were classified using a prespecified four-layer framework encompassing symptoms and function, meniscal tissue preservation, treatment failure or reoperation, and long-term joint protection. The primary endpoint was the presence of at least one preservation-oriented primary outcome. Exploratory associations were examined using Firth penalized logistic regression. Of 724 unique records, 136 trials comprising 1,093 registered outcomes were included. Twenty-nine trials (21.3%) included a preservation-oriented primary outcome, and 62 (45.6%) included a preservation-oriented outcome at any registered level. Long-term joint protection was designated as a primary outcome in 10 trials (7.4%) and assessed at any level in 33 (24.3%). Conversely, 99 trials (72.8%) limited substantive primary efficacy assessment to symptoms, function, or physical performance, and 68 (50.0%) met the strict short-term-oriented pattern. No covariate reached statistical significance for the primary endpoint. In sensitivity analyses, multicenter conduct (OR 3.29, 95% CI 1.18–9.75) and follow-up of at least 24 months (OR 3.27, 95% CI 1.29–8.71) were associated with the inclusion of any preservation-oriented outcome. Repair or surgical-technique and biologic or injection interventions also showed positive associations relative to rehabilitation or exercise. Although preservation-oriented interventions are common in registered meniscus trials, outcome selection and follow-up remain focused on short-term clinical improvement. Future trials should better determine whether treatment preserves meniscal tissue, delays osteoarthritis progression, and improves long-term outcomes for patients with meniscal disorders. Not applicable. This cross-sectional meta-research study analyzed publicly available registered trials and did not prospectively assign human participants to an intervention.