Surgery vs Physiotherapy for Osteoarthritis and Meniscal Tear
Osteoarthritis is one of the most common reasons for visits to the physiotherapist by individuals over the age of 50. Meniscal tears are also very common among this age group and can occur in people that don’t complain of knee pain. A study published in the New England Journal of Medicine challenges the thought that surgery is better than physiotherapy for the treatment of knee pain caused by arthritis and meniscal tears.
351 individuals over the age of 45 with both osteoarthritis and meniscal tears participated in this multi-centre randomized controlled trial. One group was assigned arthroscopic surgery followed by physiotherapy; the other group only received physiotherapy.
In the surgical group patients received a partial meniscectomy, removal of bone and cartilage fragments (debridement), followed by the same physiotherapy protocol that the nonsurgical group received. The nonsurgical group received physiotherapy treatment twice a week along with home exercises. Physiotherapy lasted six weeks and addressed inflammation, strength, range of motion, muscle tightness, proprioception, and balance. Both groups were allowed to take acetaminophen or antiinflammatories when needed for pain. Some patients in both groups received cortisone shots.
Results: Pain and function outcome measures in both groups had similar improvements at the 6 and 12 month points into the study. Adverse outcomes were similar between the groups, and 30% of the physiotherapy group went on to have surgery because they weren’t responding. 6%of patients in the surgical group opted not to have surgery. A similar number of patients in both groups went on to have knee replacements over the study period.
The results of this study suggest it is prudent for those middle aged people who suffer from poor knee function due to arthritis and meniscal tears to partake in physiotherapy before considering surgery and its associated risks. Surgery should be left for those who don’t respond to more conservative measures, and we have to realize that even with surgery, results are not guaranteed.
Dr Qureshi | Nov 19, 2018 at 8:47 am
Many MRI’s are ordered by family doctors who rely on them to make a diagnosis. As an orthopaedic surgeon we can often make this diagnosis without, so an MRI is often not needed. In a select group of patients that I feel need surgery, they will usually do very well. The article does take patients who are selected for surgery, so it is clear that too many arthroscopies are being done.
Janice | Nov 20, 2018 at 3:25 pm
Exactly, treat the patient, not the MRI. Any MRI findings must relate clinically to the patient’s complaints
David | Nov 19, 2018 at 10:27 am
I feel there is a subset of patients with knee osteoarthritis and meniscal tears that would benefit from surgery such as patients with recurring episodes of mechanical pain that causes locking or buckling. Those patients may not get lasting benefit from physiotherapy.
Janice | Nov 20, 2018 at 3:27 pm
True. We see in this study that 30% of those in the physiotherapy group went on to have surgery, but that there were no adverse outcomes when they waited 6 months.
JeffreyCloms | Nov 20, 2018 at 5:53 pm
Great work!
Stacey B | Apr 6, 2019 at 6:08 pm
Thank you for a very informative blog.
Homer | Jun 4, 2019 at 9:33 pm
Thank you for providing this review. HL
Emmanuel Love | Jun 12, 2019 at 12:20 am
Hey, how’s it going?
This is great information to hear.
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MT | Jan 1, 2020 at 1:50 pm
This is great information
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