Defining the Value of Future Research to Identify the Preferred Treatment of Meniscal Tear in the Presence of Knee Osteoarthritis
Meniscal tear (MT) is a highly prevalent condition, particularly for individuals over age 50 and those with concomitant knee osteoarthritis (OA). Symptomatic MT is often treated surgically with arthroscopic partial meniscectomy (APM), a widespread procedure performed in over 350,000 people annually between the ages of 45 and 64 in the US.
Five recent randomized controlled trials (RCTs) have evaluated APM efficacy among symptomatic patients with MT and radiographic or pre-radiographic knee OA. One most recent study established the superiority of APM compared to non-operative management, while others failed to establish superiority of APM compared to non-operative management or sham procedures, demonstrating similar pain relief between surgical and non-surgical interventions. In three of these studies, between 20% and 30% of patients originally assigned to the non-surgical arm crossed over to receive APM. A recent meta-analysis concluded that over a short time horizon (6 months), APM is superior to non-operative management, but this superiority is not observed over a longer time horizon. These data raise questions about the value of APM in patients with MT and knee OA. The high cross-over rates suggest that the most clinically effective treatment may be physical therapy (PT) followed by Delayed APM for those with persistent symptoms.