Surgery versus physical therapy for a meniscal tear and osteoarthritis.

Journal Article (Multicenter Study;Journal Article)

Background

Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain.

Methods

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.

Results

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.

Conclusions

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.).

Full Text

Duke Authors

Cited Authors

  • 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

Published Date

  • May 2013

Published In

Volume / Issue

  • 368 / 18

Start / End Page

  • 1675 - 1684

PubMed ID

  • 23506518

Pubmed Central ID

  • 23506518

Electronic International Standard Serial Number (EISSN)

  • 1533-4406

International Standard Serial Number (ISSN)

  • 0028-4793

Digital Object Identifier (DOI)

  • 10.1056/nejmoa1301408

Language

  • eng