Physical therapy compares favourably to surgery in patients with meniscal tears

Exercise-based physical therapy improves knee function similar to arthroscopic partial meniscectomy in patients with degenerative meniscal tears, according to a study.

The study included 321 patients (mean age 58 years, 50.2 percent female) with a degenerative meniscal tear. They were randomized to undergo either arthroscopic partial meniscectomy (n=159) or 16 sessions of exercise-based physical therapy (n=162).

Researchers assessed the effect of the intervention over 5 years of follow-up on patient-reported knee function (International Knee Documentation Committee [IKDC] Subjective Knee Form: range, 0 [worst] to 100 [best]), the primary study outcome. They conducted the assessment based on the intention-to-treat principle, with a noninferiority threshold of 11 points. The secondary outcome was progression in knee osteoarthritis, shown in radiographic images and assessed using the Osteoarthritis Research Society International (OARSI) atlas sum score (0 [best] to 18 [worst]).

A total of 278 participants (87.1 percent) completed the 5-year follow-up: 139 in each group, with a mean follow-up time of 61.8 months. At 5 years, IKDC questionnaire scores improved by a mean of 29.6 points in the surgery group and 25.1 points in the physical therapy group.

The crude between-group difference was 3.5 points (95 percent confidence interval, 0.7–6.3; p<0.001 for noninferiority), confirming the noninferiority of physical therapy.

Rates of progression of radiographic-demonstrated knee osteoarthritis were comparable in the intervention groups. At 5 years, the OARSI sum score progressed by 1.1 points in the surgery group (from 1.9 to 3.0) and by 1.1 points in the physical therapy group (from 2.1 to 3.4; p=0.78).

This study suggests that physical therapy should be the preferred treatment over surgery for degenerative meniscal tears. The data can inform the development and update of current guideline recommendations about treatment for patients with a degenerative meniscal tear.