Physical therapy vs. glucocorticoid injection in patients with meniscal tears and knee osteoarthritis

1. Patients with meniscus tears and knee osteoarthritis (KOA) who were randomized to physical therapy experienced improved pain and quality of life at 1 year of follow-up compared to those randomized to receive glucocorticoid injections. 

Evidence Rating Level: 1 (Excellent)

Severe tears of the meniscus may lead to KOA, wherein the most common management approach is symptomatic management until progression of KOA necessitates knee replacement. While both physical therapy and intra-articular glucocorticoid injections have been recommended for the treatment of KOA, there remains a lack of consensus on which management option is more efficacious in relieving pain and improving function. This randomized, single-blind, multi-centre randomized controlled trial therefore sought to investigate the treatment efficacy of physical therapy versus intra-articular glucocorticoid injection in patient suffering from meniscal tears and KOA. 140 patients were randomized to the glucocorticoid group (mean age, 58.11 years; 43% female) and 133 patients were randomized to the physical therapy group (mean age, 57.68 years; 41% female) from various medical centres across China. The primary outcome of the study was the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months, which measures knee pain, stiffness and physical function. At 12 months of follow-up, the physical therapy group had improvements in pain, stiffness and physical function as measured by the WOMAC score (76.85 ± 2.50 vs 99.55 ± 2.09 for the physical therapy and glucocorticoid groups respectively; mean difference = − 22.70; 95% confidence interval [95% CI] − 23.43 to − 21.96; p < 0.001). Overall, this study found that among patients with meniscus tears and knee osteoarthritis, those who received physical therapy showed improvements in pain and quality of life compared to glucocorticoids injections.

Click to read the study in BMC Medicine

Image: PD

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