Many middle-aged and older adults have severe knee pain due to a tear in the meniscus, a crucial support structure in the knee that is often damaged in people with knee osteoarthritis.
Each year in the United States, more than 450,000 arthroscopic surgeries are performed to treat meniscal tears, but scant data exist to help doctors determine if physical therapy or surgery is the best treatment for a patient, according to the researchers at Brigham and Women's Hospital in Boston.
Their study of 351 patients -- all over age 45 with knee pain, meniscal tear and knee osteoarthritis -- suggests that physical therapy may be equal to surgery for some patients.
Participants were randomly assigned to be treated with either arthroscopic surgery or physical therapy. When they were assessed six and 12 months later, both groups had substantial and similar improvements in movement.
The study was scheduled for presentation this week at the annual meeting of the American Academy of Orthopaedic Surgeons, in Chicago, and published online March 19 in the New England Journal of Medicine.
"Since both the patients who received physical therapy and those who received surgery had similar and considerable improvements in function and pain, our research shows that there is no single 'best' treatment," principal investigator Dr. Jeffrey Katz said in a hospital news release.
However, the release noted that some of the original physical therapy patients did eventually opt for surgery.
"Patients who wish to avoid surgery can be reassured that physical therapy is a reasonable option, although they should recognize that not everyone will improve with physical therapy alone. In this study, one-third of patients who received physical therapy ultimately chose to have surgery, often because they did not improve with [physical therapy]," added Katz, who is director of the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital, and a professor of medicine and orthopedic surgery at Harvard Medical School.
One expert agreed with those conclusions.
"The article reinforces the standard that if a patient suffers a degenerative meniscal tear related to mild to moderate osteoarthritis then the first line of treatment is typically physical therapy," said Dr. Leon Popovitz, an orthopedic surgeon at Lenox Hill Hospital in New York City.
"If patients do not improve, then arthroscopy is a viable option to improve their symptoms," he added.
The U.S. National Library of Medicine has more about meniscus tears .
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