Similar pain benefits with surgery and physical therapy for osteoarthritis meniscal tear
medwireNews: Patients with osteoarthritis who have degenerative meniscal tear experience pain relief with either physical therapy or arthroscopic partial meniscectomy (APM), show 5-year MeTeOR data.
The study, presented at the 2018 ACR/ARHP Annual Meeting in Chicago, Illinois, USA, involved 340 patients with osteoarthritis aged an average of 58 years. They formed three treatment groups ─ 164 who were randomly assigned to and received APM, 109 who were assigned to and received physical therapy, and 67 who were assigned to physical therapy but crossed over to undergo APM.
The three groups were similar with regard to the ratio of men and women, grade of osteoarthritis, average age, and BMI.
Pain was assessed at 6-monthly intervals using the Knee Osteoarthritis and Injury Outcome Score (KOOS) pain scale, which rates pain on a scale of 0 to 100 with 100 being the worst pain.
On average, all three groups of patients experienced “substantial improvements in pain from baseline to 12 months,” said Jeffrey Katz, from Brigham & Women’s Hospital and Harvard Medical School in Boston, Massachusetts, USA.
Crude KOOS pain scores fell from an average of 46 in patients originally assigned to strengthening-based physical therapy for 3 months or APM and from 50 in those who crossed over from physical therapy to APM to 20─25 in the three groups by 6 months, with slightly slower improvement in the latter group during which time they crossed over from physical therapy to surgery.
“These improvements in pain and function were maintained through 5 years on average,” noted Katz.
There were a total of 25 total knee replacements (TKRs) during the 5 years, affecting 7.4% of the whole cohort, but Katz pointed out that while the rate was 1.8% among patients receiving physical therapy, it was much higher, at around 10.0% in patients undergoing or crossing over to APM, giving a significant adjusted hazard ratio of 4.7.
Concerned that patients dropping out of the trial due to having a TKR might bias their results, they carried out a pattern mixture model analysis that showed there was “very little if any bias due to TKR dropout, mainly because there were relatively few of them,” Katz reported.
He said that the findings support treatment decisions for meniscal tear being “preference-driven,” given that both APM and physical therapy ─ with the option of having delayed surgery ─ resulted in similar pain levels at 12 to 60 months.
But Katz added that the higher rate of TKR in surgical patients is “unexplained, concerning, and requires further study.”
He offered two possible explanations for the higher rate: “One is the accelerated structural damage in those who are treated surgically […], another would be a greater familiarity of patients with surgery and the surgeons having had their arthroscopic surgery.”
Katz concluded that “this finding should be discussed by patients and clinicians who are contemplating treatment for knee pain and meniscal tear.”
By Lucy Piper
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