Is nonoperative therapy as effective as surgery for meniscal injuries?

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Yes. There is no significant difference in symptom or functional improvement between adult patients with symptomatic meniscal injury who are treated with operative vs nonoperative therapy (strength of recommendation: A, consistent randomized controlled trials [RCTs]).

Both approaches resulted in function and pain improvement

A 2013 multicenter RCT evaluated 351 adults, 45 years and older, with a meniscal tear and mild to moderate osteoarthritis confirmed by imaging, for functional improvement by physical therapy alone compared with arthroscopic partial meniscectomy and physical therapy.1

At the beginning of the study and 6 and 12 months after treatment, researchers assessed symptoms using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index physical-function score (0-100, with higher scores indicating more severe symptoms), the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain (0-100, with higher numbers correlating with less pain), and the 36-item Short Form Health Survey (SF-36) for physical activity (0-100, with higher scores indicating greater physical activity).

Modified intention to treat analysis showed no significant difference in function and pain improvement at 6 and 12 months between patients with meniscal injury who underwent arthroscopic repair and physical therapy and patients who underwent physical therapy alone (TABLE1). A limitation of the study was the crossover of 30% of patients from the nonoperative group to the operative group.


Evidence-based answers from the Family Physicians Inquiries Network

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