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Surgery versus physical therapy for a meniscal tear and osteoarthritis.

Publication ,  Journal Article
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 ...
Published in: The New England journal of medicine
May 2013

Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain.We conducted a multicenter, randomized, controlled trial involving symptomatic patients 45 years of age or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. We randomly assigned 351 patients to surgery and postoperative physical therapy or to a standardized physical-therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). The patients were evaluated at 6 and 12 months. The primary outcome was the difference between the groups with respect to the change 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) 6 months after randomization.In the intention-to-treat analysis, the mean improvement in the WOMAC 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 active participants in the study who were assigned to physical therapy alone (30%) had undergone surgery, and 9 patients assigned to surgery (6%) had not undergone surgery. The results at 12 months were similar to those at 6 months. The frequency of adverse events did not differ significantly between the groups.In the intention-to-treat analysis, we did not find significant differences between the study groups in functional improvement 6 months after randomization; however, 30% of the patients who were assigned to physical therapy alone underwent surgery within 6 months. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases; METEOR ClinicalTrials.gov number, NCT00597012.).

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Published In

The New England journal of medicine

DOI

EISSN

1533-4406

ISSN

0028-4793

Publication Date

May 2013

Volume

368

Issue

18

Start / End Page

1675 / 1684

Related Subject Headings

  • Tibial Meniscus Injuries
  • Severity of Illness Index
  • Recovery of Function
  • Postoperative Complications
  • Physical Therapy Modalities
  • Pain Measurement
  • Osteoarthritis, Knee
  • Middle Aged
  • Menisci, Tibial
  • Male
 

Citation

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Katz, J. N., Brophy, R. H., Chaisson, C. E., de Chaves, L., Cole, B. J., Dahm, D. L., … Losina, E. (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. The New England Journal of Medicine, 368(18), 1675–1684. https://doi.org/10.1056/nejmoa1301408
Katz, Jeffrey N., Robert H. Brophy, Christine E. Chaisson, Leigh de Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, et al. “Surgery versus physical therapy for a meniscal tear and osteoarthritis.The New England Journal of Medicine 368, no. 18 (May 2013): 1675–84. https://doi.org/10.1056/nejmoa1301408.
Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. The New England journal of medicine. 2013 May;368(18):1675–84.
Katz, Jeffrey N., et al. “Surgery versus physical therapy for a meniscal tear and osteoarthritis.The New England Journal of Medicine, vol. 368, no. 18, May 2013, pp. 1675–84. Epmc, doi:10.1056/nejmoa1301408.
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. The New England journal of medicine. 2013 May;368(18):1675–1684.

Published In

The New England journal of medicine

DOI

EISSN

1533-4406

ISSN

0028-4793

Publication Date

May 2013

Volume

368

Issue

18

Start / End Page

1675 / 1684

Related Subject Headings

  • Tibial Meniscus Injuries
  • Severity of Illness Index
  • Recovery of Function
  • Postoperative Complications
  • Physical Therapy Modalities
  • Pain Measurement
  • Osteoarthritis, Knee
  • Middle Aged
  • Menisci, Tibial
  • Male