Physical Therapy as Effective as Surgery for Meniscal Tear

Patients with knee osteoarthritis and a meniscal tear who received physical therapy without surgery had good functional improvement 6 months later, and outcomes did not differ significantly from patients who underwent arthroscopic partial meniscectomy, a new trial shows.

Patients with a meniscal tear and osteoarthritis pose a treatment challenge because it is not clear which condition is causing their symptoms.

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.

The physical therapy in both regimens  involved 1 or 2 sessions a week for about 6 weeks and home exercises. The average number of physical therapy visits was 7 in the surgery group and 8 in the non-surgery group.

 Mean Improvement in Osteoarthritis Index at 6 Months

Treatment Group	Mean Improvement (Points)	95% Confidence Interval
Surgery+ physical therapy	20.9	17.9–23.9
Physical therapy	18.5	15.6–21.5

The 12-month results were similar to the 6-month results. 

 John Mays, MD, an orthopaedic surgeon practicing in  Louisiana, USA, who was asked to comment on the findings, said most patients don't choose physical therapy. "In the real world, most people want a quick fix" and choose surgery, he noted.

Dr. Mays said he would have liked to have seen a group of patients who underwent surgery but did not receive postoperative physical therapy. He explained that his patients with osteoarthritis and meniscal tear rarely get physical therapy after arthroscopic meniscectomy; they most often do home-based exercises.

He added that "most insurance plans have limits on the number of physical therapy sessions they allow."

N Engl J Med. Published online March 19, 2013. Abstract, Editorial