Physiotherapy vs Surgery for Meniscal Tears: A Randomized Controlled Trial
Journal: New England Journal of Medicine
Year: 2013
Authors: Katz JN, Brophy RH, Chaisson CE, et al.
DOI: 10.1056/NEJMoa1301408
Key Findings
- No significant difference in functional improvement between physiotherapy and surgery groups at 12 months
- 30% of patients assigned to physiotherapy eventually crossed over to surgery
- Those who completed physiotherapy had outcomes equivalent to surgery
- Study supports trying physiotherapy before considering surgery for meniscal tears
This randomized controlled trial published in the New England Journal of Medicine compared the effectiveness of physiotherapy versus arthroscopic partial meniscectomy (surgery) for patients with meniscal tears and knee osteoarthritis.
The study included 351 patients with meniscal tears confirmed by MRI, all of whom had knee osteoarthritis. Patients were randomly assigned to either surgery plus post-operative physiotherapy, or physiotherapy alone.
Key Results
At 12-month follow-up, both groups showed similar improvements in functional outcomes and pain scores. There was no statistically significant difference between the surgery and physiotherapy groups. However, approximately 30% of patients initially assigned to physiotherapy eventually underwent surgery.
Clinical Implications
This study provides strong evidence that physiotherapy should be the first-line treatment for most patients with meniscal tears, particularly those with underlying knee osteoarthritis. Surgery can be reserved for patients who don't respond to conservative treatment.