Surgery versus Physical Therapy for a knee Meniscal Tear and Osteoarthritis
This study followed 351 patients 45 years and older, diagnosed with a meniscal tear and mild-to-moderate osteoarthritis of the knee via MRI. 174 patients were randomly assigned to a surgical group, while the remaining 177 patients were assigned to a standardized physical therapy regime. The surgical group protocol involved trimming the meniscus back to a stable rim and removing cartilage and bone fragments, while the physical therapy protocol addressed range of motion exercises, education on pain control, strength, cardiovascular and balance work. The patients were then evaluated at 6 and 12 months via the physical function score; the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patients were given the option to cross over to the surgical group at any time throughout the study.
Outcomes at 6 and 12 months:
- No significant difference in WOMAC function scores between groups at 6 months
- No signigicant differences in KOOS pain scores between groups at 6 months
- No significant difference in WOMAC function scores between groups at 12 months
- No signigicant differences in KOOS pain scores between groups at 12 month
- There was a 30% rate of crossover from the Physical Therapy group to the surgical group at the 6 month mark
The authors conclude that symptomatic patients with a meniscal tear and imaging evidence of a mild-to-moderate osteoarthritis who were assigned to either surgery or physical therapy did not differ significantly in their improvements in functional status and pain levels. Having a meniscal tear does not automatically mean that a client is a surgical candidate, but clinically is more likely when they have blocked ROM and are non responsive to treatment.
Reference: Katz et al., Surgery versus Physical Therapy for a Mensical Tear and Osteoarthritis. The New England Journal of Medicine April 2013. Retrieved from nejm.org.