Patrick J. Skerrett

Physical therapy works as well as surgery for some with torn knee cartilage

Tiny shock absorbers in the knee (each one is called a meniscus) provide a key cushion between the thighbone and the shinbone. They are prone to tearing, and sometimes just wear out. A torn meniscus can cause pain or other symptoms, like a knee that locks. But sometimes they don’t cause any symptoms.

In a youngish person, when a knee-wrenching activity like skiing, ultimate Frisbee, or slipping on the ice tears a meniscus, the damage is often repaired surgically. But a torn meniscus is often seen in the 9 million Americans with knee osteoarthritis, and for them the best course of action hasn’t been crystal clear. Results of the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial published yesterday in the New England Journal of Medicine indicate that physical therapy may be just as good as surgery.

Meniscus tear2

When the shock-absorbing cartilage in the knee is torn by injury or worn ragged by use, the result is called a meniscal tear. Stiffness and a vague sensation that the knee is not moving properly often result.

Surgeons at Harvard-affiliated Brigham and Women’s Hospital and six other large hospitals recruited 351 men and women with symptom-causing knee osteoarthritis and a meniscal tear. Half completed a six-week physical therapy program aimed at easing inflammation, strengthening muscles supporting the knee, and improving the knee’s range of motion. The other half underwent a procedure called arthroscopic partial meniscectomy, in which unstable pieces of the meniscus are removed and the remaining edges are smoothed, followed by the same physical therapy program.

Participants in both groups reported similar improvements in knee function and pain at six and 12 months. About one-third of those who received only physical therapy “crossed over” during the course of the trial and had surgery.

“We did this trial because surgeons really haven’t been sure what’s best for these patients,” said Dr. Jeffrey N. Katz, professor of medicine and orthopedic surgery at Harvard Medical School, who was one of the leaders of the trial. “Now we have a better picture, and can advise people with knee osteoarthritis and a torn meniscus that physical therapy and surgery are both good options.”

Keep in mind that the people participating in this trial had already had an MRI and been referred to a surgeon. For most people with knee osteoarthritis and a possible meniscus tear, conservative therapy is usually the place to start, especially when symptoms are mild, says Dr. Robert H. Shmerling, an associate professor of medicine at Harvard Medical School and rheumatologist at Beth Israel Deaconess Medical Center.

Making the choice

In younger people, it usually takes a strong twisting force to tear a meniscus. In people with osteoarthritis, the meniscus can tear without an injury, probably a result of ongoing degeneration of the cartilage.

Symptoms of a torn meniscus include:

  • stiffness and swelling in the knee
  • pain and tenderness along the joint line or general knee pain
  • swelling in and around the knee
  • catching or locking of the knee

As the NEJM report points out, not all meniscal tears need to be repaired. In fact, since even a torn meniscus can function as a shock absorber, it may sometimes be a better option to support it with physical therapy than surgically removing bits of it.

Next steps for the MeTeOR team include trying to determine if certain symptoms or psychosocial characteristics or other factors can identify individuals as better candidates for physical therapy or surgery.

Comments:

  1. Dr Jason Diamond Reviews

    Good Article with needful information.Physical therapy gives really good and positive results.

  2. Ronald Edwin Lane

    The ACL is the largest ligament in your knee by far, and there is a reason why it is there. It stabilizes the entire joint and is particularly important for lateral stability. Professional athletes in sport that involve planting and cutting always opt for the surgery. The study Harvard study quoted here supports that. Only 8 percent of the patients that opted for the surgery, subsequently tore cartilage or their meniscus, while 25% of those opting for the physical therapy subsequently suffered those injuries. That is a 300% increase in the likely of re-injuring your knee in the future. Athletes who only bike or run on flat ground may be fine with just physical therapy alone, but why limit yourself???? I had a partial tear of the ACL and was talked into not having surgery, that physical therapy was just as good. It’s not. Ten years later while playing volleyball–out went the knee again, and not from anything all that traumatic,simply coming down on that leg after jumping, with a little lateral momentum going that way. Nothing that would have even come close to effecting my other knee. If you want to have an active life and to keep your options open, I highly recommend that you OPT FOR THE SURGERY. The other option is all about saving the your insurance company money.

  3. Trace Power

    Really great post! Its interesting at how the body responds to injury. Depending on the type of injury usually simple strength training can reduce injuries and aid in recovery time.

  4. Alyaa Mahfouz

    Great , i hope to see more & more studies or trials to decrease the invasive maneuvers to avoid risks of surgeries!!

  5. billy mciver

    your idea is great on paper but in the real world knees joints do need surgery or is this a save money SCHEME ??? THOUGHT up bye accontants to stop docters help people with medical problems

  6. Anonymous

    It is very rare to see this kind of informative blogs. I am highly excited to see this kind of blog. It is a very useful and meaningful piece of work.

    Thanks you,
    Robert Morelli

  7. Jayne

    There are millions of people out there who are suffering from panic attacks and the fact is that many of them just don’t know what they can do in order to get a hold of their life and start living it like they used to.

  8. Kcurry

    I had a medial meniscus tear and healed it without surgery. Physical therapy retrained my movement patterns and corrected my pre-existing deficits in regards to mobility and strength, the result of which had improved my running economy and overall lower extremity stability now that I am fully healed. I’m glad to see the development of more statistical data… there is not enough standardization of care in PT due to the lack of clinical research. Admittedly, having worked in the outpatient PT field for a few years, I was confident in my ability to facilitate my healing with my own knowledge in conjunction to the therapy.

  9. Dr Pat, MD

    Glad to see this trial, and pleased to see that this write-up doesn’t omit the 30% cross-over to surgery. My experience as a patient has been that surgery was much more effective for my meniscal tears than was the very competent PT care I received for a year. I believe in the combination, with PT first to see if it alone can do the trick. Fortunately, my orthopod believes in PT, and my PT respects appropriate use of surgery.

  10. Orthodontists in London

    Good Article with needful information.Physical therapy gives really good and positive results.

  11. J DPT

    Not only is physical therapy as effective, but we PTs can actually help prevent OA, and prevent structural lesions to the knee with a thorough examination of the joint alignment, muscle imbalances of supporting musculature, and analysis of the how the athlete performs the movement.

  12. mama

    knee’s surgery or physical therapy, both give same results