Surgical vs Nonsurgical Interventions in Meniscus Tear With Knee OA

Investigators compared changes in knee MRI findings over the course of 18 months in patients with osteoarthritis and meniscal tears treated with arthroscopic partial meniscectomy or nonoperatively with physical therapy.

Patients who underwent surgical intervention for meniscal tears and osteoarthritis (OA) displayed more advancement in magnetic resonance imaging (MRI)-based markers compared with patients who were not treated surgically, according to study results published in Arthritis Care and Research.

Using 18-month follow-up data from the multicenter, randomized controlled Meniscal Tear in Osteoarthritis Research Trial ( identifier NCT00597012), researchers evaluated the early, MRI-based outcomes of surgical and nonsurgical interventions for meniscal tears and OA.

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Patients (n = 351) who were age ≥45 years and had MRI evidence of meniscal tears, MRI or x-ray evidence of OA changes, and knee symptoms were recruited from 7 orthopedic surgery clinics. From the initial treatment group, 225 patients had both baseline and 18-month MRIs; 175 patients were ultimately included in the analysis.

Patients randomly received either arthroscopic partial meniscectomy (APM) plus physical therapy (PT) (n =103) or PT alone (n =72), with the option to discuss crossing over to the surgery group if symptoms were persistent despite PT. Patients were 56% women and 89% white; mean age was 59±7 years.

Both MRIs were read by an experienced musculoskeletal radiologist, using the MRI OA Knee Score in pairs, unblinded to time. Changes at 18 months were focused on bone marrow lesions, cartilage surface area, cartilage thickness, osteophyte size, effusion-synovitis, and Hoffa synovitis.

Ultimately, patients in both treatment groups experienced “substantial changes” in MRI-based markers. The mean number of subregions with advancement in cartilage surface area score was 2.3±1.9 vs 1.3±1.6 in the APM vs PT groups; 60% of patients who underwent APM had ≥2 subregions with advancement (vs 33% in the PT group). Similarly, 38% of patients in the APM group had ≥2 subregions with advancement in cartilage thickness score vs 26% in the PT group. The APM group also experienced greater score advancement of osteophytes (3.8±3.2 vs 2.4±2.7) and effusion-synovitis (24% vs 8%). No significant associations were noted among treatment type and cartilage thickness, bone marrow lesions, or Hoffa-synovitis.

Study limitations included the crossover of patients into the surgery group, potentially disrupting the confounders inherent to randomization, and the limited generalizability of these results to a general knee OA cohort.

“This cohort with meniscal tear and OA had marked advancement in MRI-based features over 18 months,” the researchers concluded. “In discussing treatment options for symptomatic meniscal tear, patients and providers must weigh the potential benefits and risks of treatment options, including this information on structural advancements.”

The clinical relevance of these findings requires further study.


Collins JE, Losina E, Marx RG, et al; MeTeOR Investigator Group. Early MRI-based changes in patients with meniscal tear and osteoarthritis [published online April 1, 2019]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23891