EFFECT OF EARLY SURGERY VS PHYSICAL THERAPY ON KNEE FUNCTION AMONG PATIENTS WITH NONOBSTRUCTIVE MENISCAL TEARS

Review written by Todd Hargrove info

BACKGROUND & OBJECTIVE

Arthroscopic partial meniscectomy (APM) is a popular surgery for the treatment of knee pain, even though several studies have shown it does not perform better than various alternatives (4-6). This randomized controlled trial sought to determine whether physical therapy (PT) was “noninferior” to APM in improving knee function in people with nonobstructive meniscal tears.

METHODS

The study involved 321 people aged 45-70 with meniscal tears. Researchers excluded patients with knee locking, knee instability, severe osteoarthritis, and body mass index greater than 35. Participants were randomly assigned to PT or APM. PT consisted of coordination and closed kinetic chain strength exercises performed twice a week for 8 weeks.

The primary outcome measure was change from baseline in patient-reported knee function, measured at six-month intervals over two years. Function was measured on a 0-100 scale according to the International Knee Documentation Committee Subjective Knee Form. Secondary outcomes were activity level, general health, pain and osteoarthritis progression.

Researchers sought to determine whether PT was “noninferior” to surgery by comparing the knee function scores between the two groups at all time periods. The ‘non-inferiority’ margin was determined to be 8 points, which is the smallest detectable change in knee function under the scale. In other words, differences under 8 points were not considered meaningful.

This study further adds to the evidence that PT is a viable alternative to APM in the treatment of knee issues related to nonobstructive meniscal tears.

RESULTS

Over the two-year period, the APM group had functional knee improvements of 26.2 points (from 44.8 to 71.5), and the PT group improved by 20.4 points (from 46.5 to 67.7). Because the difference in improvement was less than 8 points,

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