A trial by a team at the Meniscal Tear in Osteoartiritis Research found that physical therapy was just as effective as surgery for treating knee osteoarthritis and meniscal tears.
For their trial, the research group gathered 351 patients from seven medical centers across the United States. In order to be eligible for the study, patients needed to:
- Have had a previous MRI of their osteoarthritic cartilage.
- Have at least one symptom of a meniscal tear, such as knee clicking or “giving away” that lasted for at least month despite previous treatment (drugs, limited activity, etc.).
- Be at least 45 years old.
Researchers randomly divided participants into one of two groups. Patients were either grouped into the arthroscopic partial meniscectomy plus postoperative physical therapy group, or to the physical therapy alone group.
The physical therapy regimens for both groups were largely the same. Both involved a 3-stage program that allowed the patient to progress to the next level at their own pace. Each patient participated in 1-2 sessions a week for six weeks, and they also conducted home exercises. The average number of physical therapy sessions was seven for the group who underwent surgery, and eight for the physical therapy alone group.
Investigators measured each patient’s baseline results, and then compared the results to measurements taken at 6-month and 12-month intervals. Progress was measured using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC).
Patients who underwent surgery and physical therapy registered a 20.9 on the WOMAC scale for improvement, while the physical therapy group registered 18.5 points. The 2.4 point difference between the groups was categorized as statistically insignificant when adjusted for covariance. Neither group showed a significant difference in pain management or frequency of adverse effects throughout the six-month interval. Similar results were found at the 12-month interval.
Despite the encouraging findings, it is important to note that individuals from the non-surgical group were allowed to undergo the operation at any time during the trial if they so chose. 30 percent of the patients from the non-surgical group eventually opted for the surgery.
Medical Impact
The study is worth noting because patients who do not want to undergo surgery may be able to attain similar knee function by simply pursuing aggressive physical therapy. Dr. John Mays, an orthopedic surgeon in Louisiana, said the results are fascinating because most people opt for the surgical operation when it may not be necessary.
“In the real world, most people want a quick fix,” said Mays.
Dr. Jeffery Katz, of the Brigham and Women’s Hospital in Boston, said the new information can help patients decide what treatment is right for them.
“These data suggest that there are two reasonable pathways for patients with knee arthritis and meniscal tear,” said Dr. Katz. “We hope physicians will use these data to help patients understand their choices.”
Not only will patients be more informed about the success rates of surgery and physical therapy, but the new data may keep patients healthier and wealthier. By opting for physical therapy alone, patients could avoid some of the risks of surgery, and they could save money if their insurance only partly covers the operation.
“These results should change practice,” said clinical epidemiologist Rachelle Buchbinder. “Currently, millions of people are being exposed to potential risks associated with a [surgical] treatment that may or may not offer specific benefit, and the costs are substantial.”
Dr. Silverman comments
This clinical trial is very interesting. The authors approach the meniscal tear as a symptom of the knee arthritis rather than a mechanical problem unto itself. Viewed in isolation, physical therapy that teaches a patient ways to accommodate for their problems helps them to feel more comfortable with knee arthritis, including in knees that have meniscal tears.
However, deep in the text of this study, it is noted that 30 percent of patients crossed over from only physical therapy to surgery. I guess it just wasn’t working well enough about 1/3 of the time.
The big question here is how can you tell if you should do physical therapy or choose surgery? Who wants to wait six months to find out that they should have gone to the operating room for a 15 minute low-risk knee surgery?
It is actually simple: If you start with physical therapy and the symptoms gradually improve, then you are on the right course. If however, they don’t improve within a few weeks or they plateau and stop getting better, your chance of getting better by six months is really low. Most people should know by six weeks if physical therapy alone is going to work for them.
Related source: Medscape
