TY - JOUR
T1 - Surgery versus physical therapy for a meniscal tear and osteoarthritis
AU - Katz, Jeffrey N.
AU - Brophy, Robert H.
AU - Chaisson, Christine E.
AU - De Chaves, Leigh
AU - Cole, Brian J.
AU - Dahm, Diane L.
AU - Donnell-Fink, Laurel A.
AU - Guermazi, Ali
AU - Haas, Amanda K.
AU - Jones, Morgan H.
AU - Levy, Bruce A.
AU - Mandl, Lisa A.
AU - Martin, Scott D.
AU - Marx, Robert G.
AU - Miniaci, Anthony
AU - Matava, Matthew J.
AU - Palmisano, Joseph
AU - Reinke, Emily K.
AU - Richardson, Brian E.
AU - Rome, Benjamin N.
AU - Safran-Norton, Clare E.
AU - Skoniecki, Debra J.
AU - Solomon, Daniel H.
AU - Smith, Matthew V.
AU - Spindler, Kurt P.
AU - Stuart, Michael J.
AU - Wright, John
AU - Wright, Rick W.
AU - Losina, Elena
PY - 2013
Y1 - 2013
N2 - BACKGROUND: Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain. METHODS: We conducted a multicenter, randomized, controlled trial involving symptomatic patients 45 years of age or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. We randomly assigned 351 patients to surgery and postoperative physical therapy or to a standardized physical-therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). 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 (ranging from 0 to 100, with higher scores indicating more severe symptoms) 6 months after randomization. RESULTS: In the intention-to-treat analysis, the mean improvement in the WOMAC score after 6 months was 20.9 points (95% confidence interval [CI], 17.9 to 23.9) in the surgical group and 18.5 (95% CI, 15.6 to 21.5) in the physical-therapy group (mean difference, 2.4 points; 95% CI, -1.8 to 6.5). 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. The frequency of adverse events did not differ significantly between the groups. CONCLUSIONS: In the intention-to-treat analysis, we 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 within 6 months. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases; METEOR ClinicalTrials.gov number, NCT00597012).
AB - BACKGROUND: Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain. METHODS: We conducted a multicenter, randomized, controlled trial involving symptomatic patients 45 years of age or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. We randomly assigned 351 patients to surgery and postoperative physical therapy or to a standardized physical-therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). 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 (ranging from 0 to 100, with higher scores indicating more severe symptoms) 6 months after randomization. RESULTS: In the intention-to-treat analysis, the mean improvement in the WOMAC score after 6 months was 20.9 points (95% confidence interval [CI], 17.9 to 23.9) in the surgical group and 18.5 (95% CI, 15.6 to 21.5) in the physical-therapy group (mean difference, 2.4 points; 95% CI, -1.8 to 6.5). 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. The frequency of adverse events did not differ significantly between the groups. CONCLUSIONS: In the intention-to-treat analysis, we 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 within 6 months. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases; METEOR ClinicalTrials.gov number, NCT00597012).
UR - https://www.scopus.com/pages/publications/84876480075
U2 - 10.1056/NEJMoa1301408
DO - 10.1056/NEJMoa1301408
M3 - Article
C2 - 23506518
AN - SCOPUS:84876480075
SN - 0028-4793
VL - 368
SP - 1675
EP - 1684
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 18
ER -