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Abstract
Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain. We conducted a multicenter, randomized, controlled trial involving symptomatic patients 45 years of age or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. We randomly assigned 351 patients to surgery and postoperative physical therapy or to a standardized physical-therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). The patients were evaluated at 6 and 12 months. The primary outcome was the difference between the groups with respect to the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score (ranging from 0 to 100, with higher scores indicating more severe symptoms) 6 months after randomization. In the intention-to-treat analysis, the mean improvement in the WOMAC score after 6 months was 20.9 points (95% confidence interval [CI], 17.9 to 23.9) in the surgical group and 18.5 (95% CI, 15.6 to 21.5) in the physical-therapy group (mean difference, 2.4 points; 95% CI, −1.8 to 6.5). At 6 months, 51 active participants in the study who were assigned to physical therapy alone (30%) had undergone surgery, and 9 patients assigned to surgery (6%) had not undergone surgery. The results at 12 months were similar to those at 6 months. The frequency of adverse events did not differ significantly between the groups. In the intention-to-treat analysis, we did not find significant differences between the study groups in functional improvement 6 months after randomization; however, 30% of the patients who were assigned to physical therapy alone underwent surgery within 6 months. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases; METEOR ClinicalTrials.gov number, NCT00597012.)
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1 From Brigham and Women's Hospital (J.N.K., L.C., L.A.D.-F., S.D.M., B.N.R., C.E.S.-N., D.J.S., D.H.S., J.W., E.L.) and Boston University (C.E.C., A.G., J.P.) — both in Boston; Washington University, St. Louis (R.H.B., A.K.H., M.J.M., M.V.S., R.W.W.); Rush University, Chicago (B.J.C.); Mayo Clinic, Rochester, MN (D.L.D., B.A.L., M.J.S.); Cleveland Clinic, Cleveland (M.H.J., A.M.); Hospital for Special Surgery, New York (L.A.M., R.G.M.); and Vanderbilt University, Nashville (E.K.R., B.E.R., K.P.S.).