Blog | Friday, March 22, 2013

QD: News Every Day--Knee meniscus surgery, therapy have similar outcomes

Patients with a meniscal tear and knee osteoarthritis had no significant differences in functional improvement at six months whether they underwent physical therapy or surgery, a study found.

Researchers conducted a seven-center, randomized, controlled trial that randomly assigned 351 patients 45 years of age or older with a meniscal tear and mild-to-moderate osteoarthritis to surgery and postoperative physical therapy or to a physical-therapy regimen with the option to cross over.

Results appeared online at the New England Journal of Medicine.

The mean improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score (ranging from 0 to 100, with higher scores indicating more severe symptoms) score after 6 months was 20.9 points (95% confidence interval [CI], 17.9 to 23.9) in the surgical group and 18.5 (95% CI, 15.6 to 21.5) in the physical-therapy group (mean difference, 2.4 points; 95% CI, -1.8 to 6.5).

At 6 months, 51 patients assigned to physical therapy alone (30%) opted for surgery, and 9 patients assigned to surgery (6%) had not yet undergone it.

Researchers noted that the two groups had similar functional outcomes at 6 months, and the similarity between the groups persisted through 5 years of follow-up.

"Our findings suggest that both arthroscopic partial meniscectomy and referral to physical therapy--with an opportunity to consider arthroscopic partial meniscectomy if substantial improvements are not achieved--are likely to result in considerable improvement in functional status and knee pain over a 6-to-12-month period," researchers wrote. "Given that improvements in functional status and pain at 6 months did not differ significantly between patients assigned to arthroscopic partial meniscectomy and those assigned to physical therapy alone and that 70% of the patients in the physical-therapy group did not undergo surgery, these data provide considerable reassurance regarding an initial nonoperative strategy."

An editorialist wrote, "Currently, millions of people are being exposed to potential risks associated with a treatment that may or may not offer specific benefit, and the costs are substantial. ... These results should change practice."