Surgery versus physical therapy for a meniscal tear and osteoarthritis.

Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in improved functional outcomes than nonoperative therapy is not clear.  This multicenter, randomised  controlled trial involved symptomatic patients 45 years of age or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. They randomly assigned 351 patients to surgery and postoperative physical therapy or to a standardised physical-therapy regimen. The patients were evaluated at 6 and 12 months. The primary outcome was the difference between the groups with respect to the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score 6 months after randomisation.  The study found that the mean improvement in the WOMAC score after 6 months was 20.9 points in the surgical group and 18.5 in the physical-therapy group. At 6 months, 51 active participants in the study who were assigned to physical therapy alone (30%) had undergone surgery, and 9 patients assigned to surgery (6%) had not undergone surgery. The results at 12 months were similar to those at 6 months.

This study did not find significant differences between the study groups in functional improvement 6 months after randomization; however, 30% of the patients who were assigned to physical therapy alone underwent surgery inside of 6 months.