Surgery versus physical therapy for a meniscal tear and osteoarthritis

Jeffrey N. Katz, Robert H. Brophy, Christine E. Chaisson, Leigh De Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, Ali Guermazi, Amanda K. Haas, Morgan H. Jones, Bruce A. Levy, Lisa A. Mandl, Scott D. Martin, Robert G. Marx, Anthony Miniaci, Matthew J. Matava, Joseph Palmisano, Emily K. Reinke, Brian E. Richardson, Benjamin N. RomeClare E. Safran-Norton, Debra J. Skoniecki, Daniel H. Solomon, Matthew V. Smith, Kurt P. Spindler, Michael J. Stuart, John Wright, Rick W. Wright, Elena Losina

Research output: Contribution to journalArticle

297 Citations (Scopus)

Abstract

BACKGROUND: Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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).

Original languageEnglish (US)
Pages (from-to)1675-1684
Number of pages10
JournalNew England Journal of Medicine
Volume368
Issue number18
DOIs
StatePublished - 2013

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Tears
Osteoarthritis
Intention to Treat Analysis
Confidence Intervals
Random Allocation
National Institute of Arthritis and Musculoskeletal and Skin Diseases (U.S.)
Therapeutics
Knee Osteoarthritis
Ontario
Group Psychotherapy
Randomized Controlled Trials

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Katz, J. N., Brophy, R. H., Chaisson, C. E., De Chaves, L., Cole, B. J., Dahm, D. L., ... Losina, E. (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine, 368(18), 1675-1684. https://doi.org/10.1056/NEJMoa1301408

Surgery versus physical therapy for a meniscal tear and osteoarthritis. / Katz, Jeffrey N.; Brophy, Robert H.; Chaisson, Christine E.; De Chaves, Leigh; Cole, Brian J.; Dahm, Diane L.; Donnell-Fink, Laurel A.; Guermazi, Ali; Haas, Amanda K.; Jones, Morgan H.; Levy, Bruce A.; Mandl, Lisa A.; Martin, Scott D.; Marx, Robert G.; Miniaci, Anthony; Matava, Matthew J.; Palmisano, Joseph; Reinke, Emily K.; Richardson, Brian E.; Rome, Benjamin N.; Safran-Norton, Clare E.; Skoniecki, Debra J.; Solomon, Daniel H.; Smith, Matthew V.; Spindler, Kurt P.; Stuart, Michael J.; Wright, John; Wright, Rick W.; Losina, Elena.

In: New England Journal of Medicine, Vol. 368, No. 18, 2013, p. 1675-1684.

Research output: Contribution to journalArticle

Katz, JN, Brophy, RH, Chaisson, CE, De Chaves, L, Cole, BJ, Dahm, DL, Donnell-Fink, LA, Guermazi, A, Haas, AK, Jones, MH, Levy, BA, Mandl, LA, Martin, SD, Marx, RG, Miniaci, A, Matava, MJ, Palmisano, J, Reinke, EK, Richardson, BE, Rome, BN, Safran-Norton, CE, Skoniecki, DJ, Solomon, DH, Smith, MV, Spindler, KP, Stuart, MJ, Wright, J, Wright, RW & Losina, E 2013, 'Surgery versus physical therapy for a meniscal tear and osteoarthritis', New England Journal of Medicine, vol. 368, no. 18, pp. 1675-1684. https://doi.org/10.1056/NEJMoa1301408
Katz JN, Brophy RH, Chaisson CE, De Chaves L, Cole BJ, Dahm DL et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine. 2013;368(18):1675-1684. https://doi.org/10.1056/NEJMoa1301408
Katz, Jeffrey N. ; Brophy, Robert H. ; Chaisson, Christine E. ; De Chaves, Leigh ; Cole, Brian J. ; Dahm, Diane L. ; Donnell-Fink, Laurel A. ; Guermazi, Ali ; Haas, Amanda K. ; Jones, Morgan H. ; Levy, Bruce A. ; Mandl, Lisa A. ; Martin, Scott D. ; Marx, Robert G. ; Miniaci, Anthony ; Matava, Matthew J. ; Palmisano, Joseph ; Reinke, Emily K. ; Richardson, Brian E. ; Rome, Benjamin N. ; Safran-Norton, Clare E. ; Skoniecki, Debra J. ; Solomon, Daniel H. ; Smith, Matthew V. ; Spindler, Kurt P. ; Stuart, Michael J. ; Wright, John ; Wright, Rick W. ; Losina, Elena. / Surgery versus physical therapy for a meniscal tear and osteoarthritis. In: New England Journal of Medicine. 2013 ; Vol. 368, No. 18. pp. 1675-1684.
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abstract = "BACKGROUND: Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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).",
author = "Katz, {Jeffrey N.} and Brophy, {Robert H.} and Chaisson, {Christine E.} and {De Chaves}, Leigh and Cole, {Brian J.} and Dahm, {Diane L.} and Donnell-Fink, {Laurel A.} and Ali Guermazi and Haas, {Amanda K.} and Jones, {Morgan H.} and Levy, {Bruce A.} and Mandl, {Lisa A.} and Martin, {Scott D.} and Marx, {Robert G.} and Anthony Miniaci and Matava, {Matthew J.} and Joseph Palmisano and Reinke, {Emily K.} and Richardson, {Brian E.} and Rome, {Benjamin N.} and Safran-Norton, {Clare E.} and Skoniecki, {Debra J.} and Solomon, {Daniel H.} and Smith, {Matthew V.} and Spindler, {Kurt P.} and Stuart, {Michael J.} and John Wright and Wright, {Rick W.} and Elena Losina",
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T1 - Surgery versus physical therapy for a meniscal tear and osteoarthritis

AU - Katz, Jeffrey N.

AU - Brophy, Robert H.

AU - Chaisson, Christine E.

AU - De Chaves, Leigh

AU - Cole, Brian J.

AU - Dahm, Diane L.

AU - Donnell-Fink, Laurel A.

AU - Guermazi, Ali

AU - Haas, Amanda K.

AU - Jones, Morgan H.

AU - Levy, Bruce A.

AU - Mandl, Lisa A.

AU - Martin, Scott D.

AU - Marx, Robert G.

AU - Miniaci, Anthony

AU - Matava, Matthew J.

AU - Palmisano, Joseph

AU - Reinke, Emily K.

AU - Richardson, Brian E.

AU - Rome, Benjamin N.

AU - Safran-Norton, Clare E.

AU - Skoniecki, Debra J.

AU - Solomon, Daniel H.

AU - Smith, Matthew V.

AU - Spindler, Kurt P.

AU - Stuart, Michael J.

AU - Wright, John

AU - Wright, Rick W.

AU - Losina, Elena

PY - 2013

Y1 - 2013

N2 - BACKGROUND: Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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).

AB - BACKGROUND: Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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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