Physical Therapy Equals Arthroscopic Surgery in Meniscal Tears Save

Several new trials suggest that conservative management may be as efficacious as arthroscopic surgery in patients with meniscal tears, thus contributing to the trend of fewer arthroscopic surgeries. A new trial of patients with nonobstructive meniscal tears shows no significant difference in 2 year outcomes between physical therapy and early arthroscopic partial meniscectomy.

A multicenter, noninferiority randomized clinical trial was conducted in 321 adults with nonobstructive meniscal tears (i.e., no locking of the knee joint) who were randomized to either arthroscopic partial meniscectomy (APM) or physical therapy (PT). Patients were excluded if they had knee instability, severe osteoarthritis, and body mass index greater than 35.

Nearly 90% of patients completed the 24 month trial. After 24 months of follow-up, knee function (assessed by a self-administered questionnaire) improved in the APM group by a mean of 26.2 points and in the PT group by 20.4 points (P value for noninferiority = .001).

Adverse events were infrequent and repeat surgery was rare in both groups.

These results support the role of conservative management (PT) over APM in patients with nonobstructive meniscal tears.