Grove Life Summer 2019

Torn Meniscus? Hold off on surgery! Research shows physical therapy comparable to surgery without the risks

M any people with knee osteoarthritis (OA) and a meniscal tear may be able to avoid surgery and achieve comparable relief from physical therapy, according to a recent, multisite study funded by the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases, and published in the New England Journal of Medicine. OA of the knee can cause debilitating pain and significantly limit function, especially in middle aged and older adults. A meniscal tear—a condition in which the c-shaped disc that cushions and supports the knee is damaged—occurs frequently among people with knee OA. Meniscal tears further limit mobility and can be very painful. Patients typically have two options for treatment— arthroscopic partial meniscectomy that involves surgically removing the torn part of the meniscus and stabilizing it, or physical therapy.

In the Meniscal Tear in Osteoarthritis Research trial, researchers at Brigham and Women’s Hospital in Boston and at six other clinical centers around the nation, compared surgery with physical therapy to determine if one treatment course led to better outcomes over the other. They recruited 351 men and women ages 45 and older who had mild to moderate knee OA and meniscal tear. Half of the patients were randomly assigned to receive arthroscopic partial meniscectomy with post-operative physical therapy, and half were assigned to receive physical therapy alone. Patients assigned to physical therapy had the option of undergoing surgery later in the trial if they wished. The researchers assessed each patient’s progress over one year, tracking improvements in functional status and pain levels at six months and at 12 months. After six months, both groups experienced similar and substantial improvement in function and pain levels. The people who remained in the physical therapy group through the end of the 12-month period continued to show improvements that were equivalent to those who had surgery. Meniscus pain can be from an acute injury or can be from the inflammatory chemical soup that occurs during the breaking down of underlying cartilage and bone. Most people over 50 have menisci that have begun to fray and erode; therefore MRI findings are difficult to use as conclusive evidence of meniscus tears and pain. Anecdotally, based on over 18 years of clinical orthopedic physical therapy experience, the typical symptoms of meniscal tears that often lead to surgical intervention are either frequent locking of the affected knee or buckling of the knee especially down stairs. Pain should never be a guide for surgical decisions. Physical therapy for meniscal tears involves strengthening and stabilizing the knee while doing so in a manner that allows the proper amount of weight bearing through the joint. Pounding activities like jogging, activities with quick cutting motions like tennis, and sitting too long can all make the condition worse. Therapy usually takes 6 weeks to overcome the symptoms of a torn meniscus. If you or someone you know have knee pain, come for a consult with Dr. Ben to see if Physical Therapy can get rid of your knee pain and get you back in the game.

Dr. Ben Galin, DPT, OCS Doctor of Physical Therapy Board Specialty Certification in Orthopedics 561-685-4444 BENonsitept@yahoo.com

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