title: Surgery versus physical therapy for a meniscal tear and osteoarthritis.
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.).
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. jnkatz@partners.org.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.forename: Robert H
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authors.forename: Christine E
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authors.lastname: Chaisson
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authors.lastname: de Chaves
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authors.lastname: Safran-Norton
authors.forename: Debra J
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authors.lastname: Skoniecki
authors.forename: Daniel H
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authors.lastname: Solomon
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authors.forename: Kurt P
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authors.lastname: Spindler
authors.forename: Michael J
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authors.lastname: Stuart
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authors.forename: Rick W
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authors.forename: Elena
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authors.lastname: Losina
mesh_terms: D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D007718:Knee Injuries / Q000601:surgery / Q000628:therapy; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery* / Q000628:therapy*; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000009:adverse effects; D011183:Postoperative Complications; D020127:Recovery of Function; D012720:Severity of Illness Index; D000070600:Tibial Meniscus Injuries