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▸ Surgery versus physical therapy for meniscal tear and osteoarthritis. New Engl J Med 2013;368:1675–84.
Many people with osteoarthritis (OA) of the knee have damage to the meniscus,1 which is commonly treated by surgical excision of the damaged fragment; a procedure known as partial meniscectomy. However, it is not clear whether surgery of symptomatic meniscal tears improves pain and function in people with knee OA compared to conservative treatment.
To assess whether adding arthroscopic meniscectomy to physiotherapy leads to greater improvements in pain and function than physiotherapy alone in older people with mild-to-moderate OA of the knee and a defined meniscus tear.
Participants were recruited from tertiary referral centres in the USA. Patients over 45 years old with knee OA who reported symptoms consistent with a meniscus tear that had persisted for more than 1 month were eligible. Meniscus pathology and OA were confirmed by MRI. Clinical symptoms of a meniscus tear included at least one of the following: clicking, catching, popping, giving way, pain with pivot or torque, pain that is episodic, or pain that is acute and localised to one joint line. Patients with previous knee surgery, bilateral meniscal tears, inflammatory …