Two articles published this past year have shone a light on the management of osteoarthritis and meniscal tears of the knee.
One, by Sihvonen R et.al. in the NEJM, examined 146 patient who were diagnosed on clinical grounds with non-traumatic meniscal tears. Participants were randomized to treatment with either arthroscopic partial meniscectomy or arthroscopy with sham surgery. Both groups received physical therapy in the form of a graduated exercise program.
Marked improvement was seen in both groups for pain scores. At 12 months the two groups – sham surgery plus exercise and real surgery plus exercise – showed no significant differences. Some did have more surgery – five in the sham group and two in the surgical group.
It would appear that in non-traumatic meniscal tears, surgery is not the initial treatment but that time and physical therapy should be utilized first.
Further supporting this study was one by Juhl C et.al. in Arthritis and Rheumatology that reviewed 48 trials of physical therapy compared to non-exercise interventions. Interestingly, PT programs that did not mix exercise types, aerobic, resistance or performance, were the most efficacious. Perhaps not surprisingly, quad exercises appeared to be the most beneficial in reducing pain.
Supervised three times weekly PT for at least four weeks had the best results. This recommendation is reflected in Partnership’s prior authorization criteria for knee interventions.
Excuse my pun in the title (you did pick up on it?).
Marshall Kubota, MD