Physical therapy or surgery for knee pain

Knee pain affects millions of Americans, particularly as they get older. The most common cause of knee pain is osteoarthritis, a joint disease where the cartilage between bones is lost.

 

Cartilage is the body’s natural WD-40 and acts as a grease between bones. As cartilage is lost, bones rub against each other and cause damage to the joint. The primary therapy for osteoarthritis is medications that reduce pain and inflammation like Tylenol and aspirin, weight loss and physical therapy.

When a painful knee is imaged with a X-ray or MRI, a tear in a specific strip of cartilage around the knee, called a meniscal tear, is also often found in addition to osteoarthritis. Meniscal tears most commonly occur when the knee is twisted while the foot is planted.

Unfortunately, it is difficult for doctors to determine if a patient’s knee pain is from osteoarthritis or from the meniscal tear. Both conditions are common and both have similar symptoms of pain, knee popping and knee locking.

Some doctors will recommend surgery to fix the meniscal tear while others will recommend a more conservative approach with physical therapy.

A new article in the New England Journal of Medicine suggests that an initial conservative approach with physical therapy may be a better option.

Dr. Jeffrey Katz, professor of orthopedic surgery at Harvard and co-director of the Brigham and Women’s Hospital Spine Center, and colleagues from seven large hospitals around the country studied 351 patients age 45 and older who had osteoarthritis and a meniscal tear. They randomly assigned patients to receive either surgery followed by physical therapy or physical therapy alone.

They followed the patients over time and measured their pain, stiffness, and mobility at six and 12 months. Although both groups showed improvement at six and 12 months, there was not a significant difference between the groups.

In other words, the conservative group with physical therapy alone did just as well as the more invasive group.

Katz’s findings suggest that patients with osteoarthritis and a meniscal tear may be better off with an initial trial of physical therapy rather than immediately going to surgery. Surgery has risks of infection and blood clots as well as anesthesia-related risks. In comparison, physical therapy is a relatively safer intervention and may be just as effective for many patients.

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