Physical Therapy, Surgery Provide Similar Pain Relief After Meniscal Tear With OA

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO — Patients with degenerative meniscal tears and osteoarthritis (OA)-related changes in the knee usually experience pain relief over 5 years regardless of whether they receive physical therapy or arthroscopic partial meniscectomy, according to data presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24, in Chicago, Illinois.¹

Researchers from Brigham and Women’s Hospital and Harvard Medical School in Boston conducted a multicenter, randomized trial to assess the 5-year outcomes for patients with OA-related knee pain and meniscal tear. They enrolled 351 participants with knee pain, meniscal tear, and OA changes on X-ray or magnetic resonance imaging (MRI).

Participants were randomly assigned to receive 5 years of physical therapy or physical therapy plus arthroscopic partial meniscectomy. The primary end point was pain, measured using the Knee Osteoarthritis and Injury Outcome Score Pain Scale. Scores ranged from 0-100, with 100 being the worst pain.

A total of 164 participants were randomly assigned to receive surgery, 109 were assigned to and received physical therapy, and 68 were assigned to physical therapy and crossed over to receive surgery.

Results showed similar pain improvements among all 3 treatment groups, with pain scores of 40-50 improving to 20-25 by 6 months. Researchers noted that pain scores showed little change between 6 and 60 months. Twenty-five patients had a total knee replacement during the follow-up period, and 10% of those who received arthroscopic partial meniscectomy, either immediately or after crossover, had total knee replacement compared with 2% of participants who received physical therapy with no surgery.

“For clinicians, these results suggest that patients with meniscal tear and osteoarthritic changes can be reassured that they are likely to experience improvement with either surgery or [physical therapy],” stated study coauthor Jeffrey N. Katz, MD, MSc, professor of medicine and orthopedic surgery at Harvard Medical School. “For researchers, the increased rates of knee replacement require more detailed study.”²

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Reference

1. Katz JN, Shrestha S, Losina E, et al. Five-year outcome of operative and nonoperative management of meniscal tear in the presence of osteoarthritic changes. Presented at: ACR/ARHP 2018 Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 1816.
2. Physical therapy and surgery both provide long-term pain relief after meniscal tear with OA [press release]. Chicago, IL: American College of Rheumatology. Published October 20, 2018. Accessed October 20, 2018.

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