Functional Outcomes of Surgery and Physical Therapy in Meniscal Tear and Osteoarthritis
OCTOBER 01, 2013
Frank J. Domino, MD
Frank J. Domino, MD
Katz JN, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013. 2013 May 2;368(18):1675-84. http://www.nejm.org/doi/full/10.1056/NEJMoa1301408.
This was a randomized controlled multicenter trial of 351 adults located in urban and suburban areas of the US.
All patients were at least 45 years old and had a meniscal tear, as well as evidence of mild-to-moderate osteoarthritis on imaging.
Intervention and Control
Surgical intervention and postoperative physical therapy were compared to a standardized physical therapy regimen with the option to cross over to surgery left at the discretion of the patient and surgeon.
Results and Outcomes
The differences between the 2 groups in terms of patient symptom and quality of life scores 6 months after randomization were measured with a standard tool known as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score, which ranges from zero to 100 with higher scores indicating more severe symptoms.
Using an intention-to-treat analysis, the mean improvement in the WOMAC score at 6 months was 20.9 points [95% confidence interval (CI), 17.9 to 23.9] in the surgical group and 18.5 points (95% CI, 15.6 to 21.5) in the physical-therapy group (mean difference, 2.4 points; 95% CI, −1.8 to 6.5), which was a non-statistically significant difference.
At 6 months, 30% of patients in the physical therapy arm had undergone surgery, while 6% of patients assigned to surgery had not undergone the procedure.
Similar results were recorded at 12 months, and there also were no differences in WOMAC scores, which implied no difference in symptoms or quality of life. Additionally, the frequency of adverse events did not significantly differ between the 2 groups.
In terms of functional improvement at 6 and 12 months after randomization, no significant differences were seen between the physical therapy group and the surgery with physical therapy group. However, 30% of patients who were only assigned to physical therapy underwent surgery within 6 months.