4 ms·

> Question: Is physical therapy noninferior to early surgery with arthroscopic partial meniscectomy for improving knee function among patients with nonobstruct

> Question: Is physical therapy noninferior to early surgery with arthroscopic partial meniscectomy for improving knee function among patients with nonobstructive meniscal tears? > Findings: In this noninferiority randomized clinical trial that included 321 patients, knee function that was measured by a self-administered questionnaire improved by 20.4 points in the physical therapy group vs 26.2 points in the early surgery group over a follow-up period of 24 months. The difference between the 2 treatment groups did not exceed the noninferiority margin of 8 points. > Meaning: These results demonstrate noninferiority of physical therapy compared with early surgery with arthroscopic partial meniscectomy for improving self-reported knee function in patients with nonobstructive meniscal tears. https://jamanetwork.com/journals/jama/fullarticle/2705186 https://jamanetwork.com/journals/jama/fullarticle/2705186

TylerE 6y ago
That doesn't really sound like non-inferiority to me as a layman. That's a difference of over 25%. Reading further in their additional conclusions, the surgery group also did better in both pain and general health.
- Peradine 6y ago
  Look at the graph in figure 2 - the massive overlap in the interquartlie ranges suggests that any differene in the median values can be attributed to random variation within the samples, rather than a true difference in the populations. Also its better to quote an absolute rather than relative reduction, so the difference is really 3.6%
rsync 6y ago
"Question: Is physical therapy noninferior to early surgery with arthroscopic partial meniscectomy for improving knee function among patients with nonobstructive meniscal tears?" Vertical (deep, interior) meniscal tears can actually heal, since they have a blood supply, and the surgery for them is basically a coin flip - the results of which you only learn after a nine month recovery period. You should absolutely be pursuing a rigorous course of PT to heal such a vertical meniscal tear. You should specifically look into whether your adductors (inner leg) are weaker than, and being overpowered by, your abductors (outer leg) resulting in knee valgus.
RealityVoid 6y ago
I had a meniscectomy a couple of years ago. When I looked at the monitor during the procedure, my meniscus was looking as if someone just threw an egg in boiling water, spread all around in thin strands. Kind of hard to say you'll just do PT when a night of dancing leads to locking the knee at certain points. At the way it was looking on the display, there is no way I did not have mechanical issues because of it.
- Someone 6y ago
  “Statistically not effective” doesn’t necessarily mean no patient ever gains from the treatment. It could be that we just cannot discriminate well enough between those for whom it would be a gain in health and those for whom it would be a loss. An example is the yearly checkup with a GP. It might save your life, but definitely costs time, and also may lead to somewhat risky tests for many. Better selection of those to be tested can make that much more effective.
- eulers_secret 6y ago
  Same here, same experience with my meniscus looking like loose egg white (though I was under general for the procedure, I saw pics afterward). I did PT before (didn't help, I had mechanical locking) and after (did help). PT doesn't help some physical issues, but I had shoulder problems that PT fixed 100% and they've stayed fixed for years. IMO, it's important for a physician to treat each case as unique, and start with conservative therapy and move to more invasive measures. Now I'm doing PT yet again because I have an onset of carpal tunnel syndrome, but it looks like I'll probably be going under the knife for it...
react_burger38 6y ago
Anecdotal evidence, but I tore my meniscus playing football when I was 14. I thought I would have to have surgery but the doctor just told me to use crutches and a knee brace for a while. It healed up really well, didn't have any issues afterwards.

TylerE 6y ago

That doesn't really sound like non-inferiority to me as a layman. That's a difference of over 25%. Reading further in their additional conclusions, the surgery group also did better in both pain and general health.

Peradine 6y ago
Look at the graph in figure 2 - the massive overlap in the interquartlie ranges suggests that any differene in the median values can be attributed to random variation within the samples, rather than a true difference in the populations. Also its better to quote an absolute rather than relative reduction, so the difference is really 3.6%

rsync 6y ago

"Question: Is physical therapy noninferior to early surgery with arthroscopic partial meniscectomy for improving knee function among patients with nonobstructive meniscal tears?" Vertical (deep, interior) meniscal tears can actually heal, since they have a blood supply, and the surgery for them is basically a coin flip - the results of which you only learn after a nine month recovery period. You should absolutely be pursuing a rigorous course of PT to heal such a vertical meniscal tear. You should specifically look into whether your adductors (inner leg) are weaker than, and being overpowered by, your abductors (outer leg) resulting in knee valgus.

RealityVoid 6y ago

I had a meniscectomy a couple of years ago. When I looked at the monitor during the procedure, my meniscus was looking as if someone just threw an egg in boiling water, spread all around in thin strands. Kind of hard to say you'll just do PT when a night of dancing leads to locking the knee at certain points. At the way it was looking on the display, there is no way I did not have mechanical issues because of it.

Someone 6y ago
“Statistically not effective” doesn’t necessarily mean no patient ever gains from the treatment. It could be that we just cannot discriminate well enough between those for whom it would be a gain in health and those for whom it would be a loss. An example is the yearly checkup with a GP. It might save your life, but definitely costs time, and also may lead to somewhat risky tests for many. Better selection of those to be tested can make that much more effective.
eulers_secret 6y ago
Same here, same experience with my meniscus looking like loose egg white (though I was under general for the procedure, I saw pics afterward). I did PT before (didn't help, I had mechanical locking) and after (did help). PT doesn't help some physical issues, but I had shoulder problems that PT fixed 100% and they've stayed fixed for years. IMO, it's important for a physician to treat each case as unique, and start with conservative therapy and move to more invasive measures. Now I'm doing PT yet again because I have an onset of carpal tunnel syndrome, but it looks like I'll probably be going under the knife for it...

react_burger38 6y ago

Anecdotal evidence, but I tore my meniscus playing football when I was 14. I thought I would have to have surgery but the doctor just told me to use crutches and a knee brace for a while. It healed up really well, didn't have any issues afterwards.