Predictors and Outcomes of Crossover to Surgery from Physical Therapy for Meniscal Tear and Osteoarthritis: A Randomized Trial Comparing Physical Therapy and Surgery

• Published in: Journal of bone and joint surgery. American volume 2016-11, Vol.98 (22), p.1890-1896
• Main Authors: Katz, Jeffrey N., Wright, John, Spindler, Kurt P., Mandl, Lisa A., Safran-Norton, Clare E., Reinke, Emily K., Levy, Bruce A., Wright, Rick W., Jones, Morgan H., Martin, Scott D., Marx, Robert G., Losina, Elena
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Cross-Over Studies; Female; Humans; Knee Joint - surgery; Male; Middle Aged; Orthopedic Procedures - methods; Osteoarthritis, Knee - surgery; Osteoarthritis, Knee - therapy; Pain Measurement; Physical Therapy Modalities; Prognosis; Recovery of Function - physiology; Scientific; Tibial Meniscus Injuries - surgery; Tibial Meniscus Injuries - therapy; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.15.01466

Arthroscopic partial meniscectomy (APM) combined with physical therapy (PT) have yielded pain relief similar to that provided by PT alone in randomized trials of subjects with a degenerative meniscal tear. However, many patients randomized to PT received APM before assessment of the primary outcome. We sought to identify factors associated with crossing over to APM and to compare pain relief between patients who had crossed over to APM and those who had been randomized to APM. We used data from the MeTeOR (Meniscal Tear in Osteoarthritis Research) Trial of APM with PT versus PT alone in subjects ≥45 years old who had mild-to-moderate osteoarthritis and a degenerative meniscal tear. We assessed independent predictors of crossover to APM among those randomized to PT. We also compared pain relief at 6 months among those randomized to PT who crossed over to APM, those who did not cross over, and those originally randomized to APM. One hundred and sixty-four subjects were randomized to and received APM and 177 were randomized to PT, of whom 48 (27%) crossed over to receive APM in the first 140 days after randomization. In multivariate analyses, factors associated with a higher likelihood of crossing over to APM among those who had originally been randomized to PT included a baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Score of ≥40 (risk ratio [RR] = 1.99; 95% confidence interval [CI] = 1.00, 3.93) and symptom duration of