Physical Therapy or Surgery Provide Long-Term Pain Relief in Patients with Meniscal Tear and Osteoarthritis

New research indicates that patients with meniscal tear and osteoarthritic changes in the knee can achieve similar pain improvement in the long term whether they receive arthroscopic partial meniscectomy (APM) or physical therapy (PT).

Osteoarthritis (OA) is a common, painful joint disease characterized by breakdown in cartilage between bones in a joint. It often affects patients in middle age or older. Recent studies of operative and non-operative treatment of meniscal tears in patients with OA have mostly focused on short-term outcomes.

The team of researchers from Brigham and Women’s Hospital and Harvard Medical School in Boston examined long-term outcomes and presented their findings at the annual meeting.

The randomized trial enrolled 351 patients, 57% of whom were female, and the sample’s mean age was 58 years. All patients had knee pain, meniscal tear, and OA changes on X-ray or magnetic resonance imaging (MRI). After excluding 10 patients, the study had three comparison groups:

• 164 received APM immediately
• 68 were randomized to receive PT and crossed over to receive APM
• 109 were randomized to and received PT

Two-thirds of the participants (66%) completed nine or more of 12 follow-up questionnaires, and completion rates were similar across all treatment groups. The study’s primary outcome was pain, as measured by the Knee Osteoarthritis and Injury Outcome Score Pain Scale, which scores pain on a range from zero to 100, with 100 representing the worst pain.

All three groups had similar pain improvement, with baseline pain scores of 40 to 50 improving to 20 to 25 by six months and then changing little between six and 60 months. The researchers concluded that people with degenerative meniscal tears achieve substantial pain relief over five years irrespective of their initial treatment.