Physical therapy may be alternative to surgery for patients with nonobstructive meniscal tears
Patients with nonobstructive meniscal tears may benefit from physical therapy as an alternative to surgery, according to recently published results.
Victor A. van de Graaf, MD, and colleagues randomly assigned 321 patients with nonobstructive meniscal tears to undergo either arthroscopic partial meniscectomy or a physical therapy protocol which consisted of 16 sessions of exercise therapy for 8 weeks focused on coordination and closed, kinetic chain strength exercises. Change in patient-reported knee function on the IKDC subjective knee form scores from baseline during a 24-month follow-up period was identified as the primary outcome measure.
Results showed 90% of 321 patients completed the trial. During the 24-month follow-up period, researchers found 29% of patients in the physical therapy group underwent arthroscopic partial meniscectomy and 5% of patients in the arthroscopic partial meniscectomy group did not undergo surgery. Patients in the arthroscopic partial meniscectomy group and the physical therapy group experienced improvements in knee function by 26.2 points and 20.4 points, respectively. Researchers noted an overall between-group difference of 3.6 points, which van de Graaf told Healio.com/Orthopedics “was smaller than the predefined non-inferiority margin of eight points, indicating non-inferiority of [physical therapy] PT as compared to [arthroscopic partial meniscectomy] APM.”
Overall, results showed 18 patients in the arthroscopic partial meniscectomy group and 12 patients in the physical therapy group experienced adverse events. The most frequent were repeat surgery and additional outpatient visits for knee pain.
“We found physical therapy to be non-inferior to surgery for the outcome [of] patient-reported knee function,” van de Graaf said. “Our results confirm the findings from previous studies and justify an initial conservative approach with physical therapy in patients older than 45 years with a nonobstructive meniscal tear.” – by Casey Tingle
Disclosures: van de Graaf reports that he receives grants from the Netherlands Organization for Health Research and Development, Achmea Healthcare Foundation and the Foundation of Medical Research OLVG, Amsterdam, the Netherlands. Please see the full study for a list of all other authors’ relevant financial disclosures.