Tuesday, March 19, 2013 New in the Literature: No Significant Difference Between Surgery and Physical Therapy for Meniscal Tear and Knee Osteoarthritis (NEJM. 2013 Mar 19.) There were no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone, say authors of an article published in the New England Journal of Medicine. The multicenter, randomized, controlled trial involved 351 symptomatic patients aged 45 years or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis. Subjects randomly were assigned either to surgery and postoperative physical therapy or to a standardized physical therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). Patients were evaluated at 6 and 12 months, primarily using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score (ranging from 0 to 100, with higher scores indicating more severe symptoms) 6 months after randomization. In the intention-to-treat analysis, the mean improvement in the WOMAC score after 6 months was 20.9 points (95% confidence interval [CI], 17.9 to 23.9) in the surgical group and 18.5% (95% CI, 15.6 to 21.5) in the physical therapy group (mean difference 2.4 points, 95% CI, -1.8 to 6.5). At 6 months, 51 active participants in the physical therapy alone group (30%) had crossed over to undergo surgery, and 9 patients in the surgery group (6%) had not undergone surgery. The results at 12 months were similar to those at 6 months, say the authors, and the frequency of adverse events did not differ significantly between the groups. The authors say their findings suggest that both options are "likely to result in considerable improvement … over a 6-12 month period." However, they continue that "these data provide considerable reassurance regarding an initial nonoperative strategy."