What's the best treatment for a torn meniscus?

Many middle age and older adults have serious knee pain due to a tear in the meniscus, an important supporting structure that is often damaged in people who have osteoarthritis. In the United States, more than 450,000 arthroscopic surgeries are performed each year to treat these injuries. Now, new research from Brigham and Women’s Hospital (BWH), suggests that treatment with physical therapy, with an option for arthroscopic surgery if patients do not respond, may prove as effective as initial treatment with surgery.

“These results are extremely valuable and will enable us to work with patients and their families to identify the treatment that is best aligned with patients’ preferences,” said Dr. John Wright, an orthopedic surgeon at BWH and lead orthopedist on the study.

In the MeTeOR (Meniscal Tear in Osteoarthritis Research) Trial, BWH researchers studied 351 patients at seven medical centers. Patients were over 45 years old, had knee pain, a meniscal tear, and osteoarthritis in the knee. They were randomly chosen to receive either arthroscopic surgery or physical therapy. One-third of patients who received physical therapy chose to have surgery later in the study, generally because of persistent pain. However, the remaining two-thirds of patients in the physical therapy group saw improvements in their pain and physical function that were similar to the patients who had surgery.

“Patients who wish to avoid surgery can be reassured that physical therapy is a reasonable option, although they should recognize that not everyone will improve with physical therapy alone,” said Dr. Jeffrey N. Katz, director of the Orthopedic and Arthritis Center for Outcomes Research at BWH and a lead investigator on the study.

If you’re experiencing knee pain due to arthritis or another condition, it’s important to work with your physician to select the option that makes sense for you.

“We hope these findings will help physicians and their patients with knee pain, meniscal tear, and osteoarthritis to discuss the likely outcomes of surgery and physical therapy and make informed treatment decisions,” advises Dr. Elena Losina, Co-Director of the Orthopedic and Arthritis Center for Outcomes Research at BWH and senior author of the study.

You can read the complete study results in the New England Journal of Medicine.

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– Jamie R.

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