My uncle was a dairy farmer. He had a saying that went like this: farmers like to plow and surgeons like to cut. When you are used to doing something (and getting paid for it) the tendency is to keep doing it. Surgical repair of meniscal tears is a common orthopedic procedure for knee pain. Over half a million arthroscopic partial meniscectomies are performed annually in the United States. A new study suggests that physical therapy (PT) may be just as good as surgery for many meniscal tears (JAMA, Oct. 2, 2018)
More Research on Meniscal Tears:
Over the last six years, several studies have reported that arthroscopic partial meniscectomies were no better than physical therapy or sham surgery when it came to knee function. Here is an article we wrote a few years ago:
Sham Knee Surgery Just As Good as The Real Thing:
A question that remained unanswered, however, was whether the benefits of physical therapy would persist.
Long-Term Benefits of PT for Meniscal Tears
Researchers in the Netherlands recruited 321 patients who were diagnosed with meniscal tears. They were randomly assigned to receive surgery or physical therapy. After two years, about a third of the patients who did physical therapy had surgery after all. But there was no significant difference between the groups with respect to knee function.
Researchers have come up with a most unusual way to describe the no-difference outcome. They call it noninferiority. In other words, the Brand X apple sauce is noninferior to the Brand Y apple sauce. We find this kind of doctorspeak confusing at best and misleading at worst. Here, read it for yourself:
“This multicenter RCT [randomized controlled trial] showed that, in patients older than 45 years old with knee pain and nonobstructive meniscal tears, PT [physical therapy] was noninferior to APM [arthroscopic partial meniscectomy] for knee function over a 24-month follow-up period. The results of this trial support the recommendations from the current guidelines that PT may be considered an appropriate alternative to APM as first-line therapy for patients with meniscal tears.”
Simply stated, the investigators conclude that physical therapy is a reasonable alternative to surgery for certain common meniscal tears.
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