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Study: Physical therapy as effective as surgery for patients with meniscal tear, knee OA

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Physical therapy was as effective at treating meniscal tears and knee osteoarthritis as arthroscopic surgery, according to this study from the New England Journal of Medicine.

“Our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial,” Clare Safran-Norton, PT, PhD, OCS, lead study author, stated in a press release. “These findings should help surgeons, physicians, physical therapists and patients in decision-making regarding their treatment options.”

Safran-Norton and colleagues screened 14,430 patients in seven university and orthopedic centers. Of these patients, 351 patients were randomly assigned to either arthroscopic partial meniscectomy or physical therapy. Patients in the physical therapy group had individualized treatment and a progressive home exercise program. They also had the option of having surgery if their symptoms did not approve.

WOMAC scores improved for patients in the physical therapy group at 6-month follow-up by 18.5 points, while patients in the surgery group had a 20.9 point increase in their WOMAC scores. Knee injury and Osteoarthritis Outcome Scores (KOOS) for patients who underwent surgery decreased by mean 24.2 points at 6-month follow-up compared to patients who followed physical therapy, who had a mean decrease of 21.3 points in their KOOS pain scores.

By 6-month follow-up, 30.2% (51 patients) of patients assigned to physical therapy alone had elected to undergo arthroscopic surgery and 9 patients in the surgery group had elected to not undergo the procedure. Between 6-month and 12-month follow-up, 4.7% (8 patients) in the physical therapy group opted to have the surgery.

Safran-Norton and colleagues noted the patients who chose to undergo surgery after physical therapy prior to 6-month follow-up had similar WOMAC scores to patients in the surgery group. Overall, patients in the physical therapy group who decided on surgery did not show better functional scores from baseline until crossover, they wrote in their study.

Reference:

Katz JN. New Engl J Med. 2013;doi:10.1056/NEJMoa1301408.

Disclosure: The authors reported various financial disclosures. See the full study for a complete list of disclosures.