Arthroscopic Treatment of Knee OA

Not all that long ago, arthroscopic surgery was routinely used to treat patients with knee OA. This practice was first called into question by a study published iKnee x-rayn 2002. In this study subjects received arthroscopic debridement, arthroscopic lavage or a placebo surgery in which the scope was inserted but nothing was done. There were no differences in pain or function between the three groups. Another trial compared the effectiveness of arthroscopic debridement to non-operative care. Again, there was no advantage to having the surgery.  A study of 90 patients by Herrlin et al looked at partial meniscectomy in patients with OA and found no advantage over physical therapy at 6 months and 5 years.
A recent RCT performed by Katz et al (METEOR trial) looked to confirm these results with a larger multi-centered study. 351 subjects from 7 institutions were randomized into a surgical group or a physical therapy group. The surgical group had a partial meniscectomy and the physical therapy group “was designed to address inflammation, range of motion, concentric and eccentric muscle strength, muscle-length restrictions, aerobic conditioning (e.g., with the use of a bicycle, elliptical machine, or treadmill), functional mobility, and proprioception and balance” and was administered in three stages. Overall the physical therapy protocol seemed reasonable and did include manual therapy. The description of the protocol (which can be found here) did not give specifics on the manual therapy (which joints and which techniques) and did not give detailed information on the intensity of the exercise. Outcomes were measured (6 and 12 months) using the physical function scale of the WOMAC, KOOS and the SF-36.
The authors found no significant difference between the groups at 6 and 12 months. There was a 30%(6 months) and 35% (12 months) cross over from conservative to the surgical group. The authors did an intent-to-treat analysis to try and deal with this cross over.
Overall this is a good study and it confirms that physical therapy is a viable option for symptomatic patients with OA and meniscus tears. Hopefully this data will help to reduce the over 465,000 partial meniscectomies performed in the US each year.

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  • It is great that studies looking at this are popping up. I’ve found that patients that go in for this surgery, especially after starting PT prior to surgery and then come back after, are really just set back a week or two. The progress appears to be the same and the end result appears to be the same. The only difference is the patient went through a surgery! I have nothing against surgery if PT isn’t working, but if there are no differences, PT is clearly the cheaper and less invasive option.

    smartlifeseries June 24, 2013 1:50 am Reply

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