by Andrew Provost, PT
A review of the literature on the treatment of meniscal tears and knee OA.
A recent research study in the New England Journal of Medicine (NEJM) showed that physical therapy is as effective as arthroscopic surgery for treating patients with meniscal tears and osteoarthritis of the knee. This study validated the idea that therapy could be used as a conservative alternative to surgery. The study looked at 351 patients aged 45 years or older who had a meniscus tear and moderate osteoarthritis of the knee. The study participants were randomly assigned to either surgery with post-operative physical therapy or physical therapy only. At 6 months, both groups showed similar improvements in their functional status and pain. The results also showed that 70% of patients who underwent just physical therapy were able to avoid surgery all together.
Meniscal tears have been observed via imaging in 35% of people older than 50 years of age, with 2/3 of those being asymptomatic. This high prevalence of meniscal tears and osteoarthritis can make it difficult to pinpoint the exact symptomatic cause of pain in the knee.
The level and progression of symptoms for patients with osteoarthritis can vary considerably ranging from very minor symptoms in early stages to very severe in later stages. It should be noted that treating patients with osteoarthritis with or without a meniscus tear is easier to manage when the patient is the in the earlier stages of symptoms. Treating knee symptoms early, at any stage of life, can make the difference between simple lifestyle changes and more complicated symptoms later in life.
Katz. 2013. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. http://www.nejm.org/doi/full/10.1056/NEJMoa1301408
Andrew Provost is a Physical Therapist at Boston Sports Medicine