Surgery versus physical therapy for a meniscal tear and osteoarthritis.
This good quality, multicentre RCT involving symptomatic patients 45 years of age or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. 351 patients were randomised to surgery and postoperative physiotherapy (PT) or to a standardised PT programme (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 WOMAC score 6 months after randomisation.
Intention-to-treat analysis (ITT) demonstrated a mean improvement in the WOMAC score after 6 months of 20.9 points (95% CI,17.9 to 23.9) in the surgical group and 18.5 (95% CI, 15.6 to 21.5) in the PT 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 PT 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.
The ITT did not find significant differences between the study groups in functional improvement 6 months after randomisation; however, 30% of the patients who were assigned to PT alone underwent surgery within 6 months > From Katz et al., N Engl J Med 368 (2013) 1675-1684. All rights reserved to The New England Journal of Medicine.
Read the free full text article for more information.