Many people with knee osteoarthritis (OA) and a meniscal tear may be able to avoid surgery and achieve comparable relief from physical therapy, according to a recent, multisite study funded by the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases, and published in the New England Journal of Medicine.
OA of the knee can cause debilitating pain and significantly limit function, especially in middle-aged and older adults. A meniscal tear—a condition in which the c-shaped disc that cushions and supports the knee is damaged—occurs frequently among people with knee OA. Meniscal tears further limit mobility and can be very painful. Patients typically have two options for treatment—arthroscopic partial meniscectomy that involves surgically removing the torn part of the meniscus and stabilizing it, or physical therapy. However, it is not always clear which treatment should be the first course of action.
In the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, researchers at Brigham and Women’s Hospital in Boston and at six other clinical centers around the nation, compared surgery with physical therapy to determine if one treatment course led to better outcomes over the other. They recruited 351 men and women ages 45 and older who had mild to moderate knee OA and meniscal tear. Half of the patients were randomly assigned to receive arthroscopic partial meniscectomy with post-operative physical therapy, and half were assigned to receive physical therapy alone. Patients assigned to physical therapy had the option of undergoing surgery later in the trial if they wished. The researchers assessed each patient’s progress over one year, tracking improvements in functional status and pain levels at six months and at 12 months.
After six months, both groups experienced similar and substantial improvement in function and pain levels. However, 30 percent of patients assigned to physical therapy alone elected to undergo surgery within six months of enrolling in the study because their symptoms were not improving or were worsening. The people who remained in the physical therapy group through the end of the 12-month period continued to show improvements that were equivalent to those who had surgery.
"These results should help guide clinicians and patients when deciding how to manage meniscal tears and knee OA," said lead investigator and author Jeffrey N. Katz, M.D., of Brigham and Women’s Hospital and Harvard Medical School. "It is reassuring to know that physical therapy for managing the condition is a valid choice for people who may want to avoid surgery. But, physical therapy will not help all patients, and for those who do not improve with it, surgery remains an effective option."
It is uncertain if those who undergo surgery for a meniscal tear are at greater risk for progression of their underlying knee OA compared to those who only receive physical therapy. The researchers plan to monitor MeTeOR participants over five years to determine if long-term outcomes differ between the two groups.
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Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, Donnell-Fink LA, Guermazi A, Haas AK, Jones MH, Levy BA, Mandl LA, Martin SD, Marx RG, Miniaci A, Matava MJ, Palmisano J, Reinke EK, Richardson BE, Rome BN, Safran-Norton CE, Skoniecki DJ, Solomon DH, Smith MV, Spindler KP, Stuart MJ, Wright J, Wright RW, Losina E. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. N Engl J Med. 2013 May 2;368(18):1675-84. PMID: 23506518. NCT00597012
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