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.
Katz, J. N., Brophy, R. H., Chaisson, C. E., De Chaves, L., Cole, B. J., Dahm, D. L., … & Levy, B. A. (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine, 368(18), 1675-1684.