Achieving Longer-Term Pain Relief after Meniscal Tear in Patients with Knee OA
Patients with meniscal tears and osteoarthritic changes in their knee generally experience substantial pain relief for at least 5 years after treatment whether they undergo physical therapy (PT) or arthroscopic partial meniscectomy (APM), according to new research findings presented at the 2018 ACR/ARHP Annual Meeting.
Recent studies of surgical and non-operative treatment of meniscal tears in knee osteoarthritis (OA) patients have focused on short-term outcomes. In this new study, researchers at Brigham and Women’s Hospital and Harvard Medical School in Boston examined 5-year outcomes for patients with OA-related knee pain and meniscal tear.
“These patients care about what happens over a longer time frame than 1 to 2 years,” said Jeffrey N. Katz, MD, MSc, Professor of Medicine and Orthopedic Surgery at Harvard Medical School and the study’s lead author.
In the multicenter, randomized trial, researchers enrolled patients with knee pain, meniscal tear, and OA changes seen on radiographs or MRI. They compared outcomes at 5 years after treatment among patients randomized to PT or to PT plus APM. The primary outcome in the study was pain as assessed by the Knee Osteoarthritis and Injury Outcome Score (KOOS) Pain Scale (0 to 100 scale, with 100 being the worst pain). The secondary outcome was the need for total knee arthroplasty (TKA).
The 351 study participants had a mean age of 58 and 57% were female. The researchers compared results in 3 groups:
- 164 who randomized to undergo APM immediately
- 68 who were randomized to receive PT but crossed over to undergo APM
- 109 who were randomized to receive PT immediately
Ten participants were randomized to APM but did not undergo the procedure and were excluded from the study analysis. Sixty-six percent of the participants completed 9 or more of 12 follow-up questionnaires, with similar completion rates across all treatment groups.
The study’s findings showed similar pain improvement in the 3 treatment groups, with baseline KOOS pain scores of 40 to 50 improving to 20 to 25 by 6 months and showing little change between 6 and 60 months. Twenty-five patients (7%) in the study had a TKA during the follow-up period. Ten percent of those who underwent APM (immediately or after cross over) had TKA, compared with 2% who received PT but had no surgery for the meniscal tear.
The researchers concluded that patients with degenerative meniscal tears generally experience substantial pain relief in at least the first 5 years after treatment, irrespective of the initial treatment. The greater chance of undergoing TKA after surgical treatment of a meniscal tear that was seen in this study will need to be examined further in other studies.
“For clinicians, these results suggest that patients with meniscal tear and osteoarthritic changes can be reassured that they are likely to experience improvement with either surgery or PT,” Dr. Katz said. “For researchers, the increased rates of knee replacement require more detailed study.”
Katz JN, Shrestha S, Losina E, et al. Five-year outcome of operative and nonoperative management of meniscal tear in the presence of osteoarthritic changes (Abstract 1816). Presented at the ACR/ARHP Annual Meeting, October 21-24, 2018, in Chicago, Illinois.