Most meniscal tears of knee require physical therapy not surgery

A new study reiterates that most meniscal tears may just require physical therapy and not surgery.

No significant difference in outcomes was found between meniscectomy and a sham procedure among patients with knee pain and meniscal tears without osteoarthritis suggesting physical therapy(PT) to remain the initial treatment for such patients, reports a study published in the journal JAMA Network.

Meniscal tears may occur as part of a degenerative process of the knee joint and occur in up to 60% of persons older than 50 years of age without knee pain Arthroscopic partial meniscectomy (APM) is among the most frequently performed procedures in orthopedic surgery.

Victor A and associates conducted a randomized clinical trial assessing whether PT is noninferior to arthroscopic partial meniscectomy (APM) for improving patient-reported knee function in patients with meniscal tears.

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The trial included 321 patients aged between 45-60 years.The patients were randomly assigned to APM (n = 159) or a predefined PT protocol (n = 162). The primary outcome was changed in patient-reported knee function.

Key study findings:

• In the PT group, 47 participants (29%) had APM during the 24-month follow-up period, and 8 participants randomized to APM (5%) did not have APM.


• Over a 24-month follow-up period, knee function improved in the APM group by 26.2 points (from 44.8 to 71.5) and in the PT group by 20.4 points (from 46.5 to 67.7).


• Adverse events occurred in 18 participants in the APM group and 12 in the PT group.


• Repeat surgery (3 in the APM group and 1 in the PT group) and additional outpatient visits for knee pain (6 in the APM group and 2 in the PT group) were the most frequent adverse events.

Although noninferiority was demonstrated for the overall between-group difference in patient-reported knee function, and for the 3- and 6-month follow-up time points, results did not demonstrate noninferiority at the 12- and 24-month time points.

The authors suggest that Longer follow-up will provide more details on the effect of time on the between-group differences.

The study concluded that, in patients older than 45 years with knee pain and nonobstructive meniscal tears, PT was noninferior to APM for knee function over a 24-month follow-up period. The results of this trial support the recommendations from the current guidelines that PT may be considered an appropriate alternative to APM as first-line therapy for patients with meniscal tears.

For reference log on to 10.1001/jama.2018.13308