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Is Surgery Necessary for a Meniscal Tear and Osteoarthritis?

Osteoarthritis is one of the most common knee conditions, with an estimated 9 million sufferers in the United States alone. In addition to this degenerative disease, meniscal tears are quite common in older adults. The meniscus, which cushions both the outer and inner edges of the knee, gets worn over time and significant use. Therefore, meniscal tears are quite common in older adults, especially those who suffer from osteoarthritis.

Osteoarthritis patients who've suffered a meniscal tear often undergo corrective surgery, followed by a physical therapy program for rehabilitation. However, some clinicians argue that patients can experience the same benefits by undergoing corrective physical therapy without the need for surgery.

Researchers from Brigham and Women's Hospital, Washington University and other orthopedic centers decided to conduct a study with the aim of demonstrating if patients who received just physical therapy were able to function as well as patients who opted for surgery and post-operative physical therapy. Researchers conducted a randomized and controlled trial that involved patients over 45 years of age with a meniscal tear and mild-to-moderate osteoarthritis. All 351 patients were randomly assigned to two groups: one group consisted of surgery and post-operative physical therapy, while the other group opted for physical therapy alone.

At the six month mark, researchers concluded that there was little difference in physical function outcomes between patients in the first group and patients in the second group. However, the study reveals an interesting point at the 12-month mark, when researchers find that 30% of patients who were assigned to physical therapy alone had to undergo surgery. This interesting study may reveal that while physical therapy can provide short-term relief from meniscal tears and osteoarthritis, patients might require surgery in order to enjoy long-term improvements in their physical function outcomes.

So what does this mean for clinicians? Quite simply, a combination of surgery and physical therapy might provide the best solution, both short-term and long-term, for patients who have a meniscal tear and mild-to-moderate osteoarthritis. This will need to be at the clinician and patient's discretion, as the study did underscore how 70% of physical therapy-only patients did not need surgery at the 12-month mark. However, the study is successful in pointing out that for many patients, surgery is absolutely necessary to long-term healing and positive physical function outcomes.

As reported in the March 2013 issue of The New England Journal of Medicine.

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