Here’s another case of less is more when it comes to medicine. Data from the ESCAPE trial in the Netherlands concludes that physical therapy is the preferred treatment over surgery for treating degenerative meniscal tears in the knee. After five years, patients who had 16 sessions of physical therapy had basically the same knee function as those who had costly and potentially risky surgery.
According to MedPage Today, movement scientist Julia Noorduyn of the Netherlands and her team of researchers assessed the progression of people suffering from knee osteoarthritis and published their findings last month in JAMA Network Open. The authors concluded that “physical therapy was not inferior to arthroscopic partial meniscectomy. The findings of this trial support the recommendation that exercise-based physical therapy should be the preferred treatment over surgery for degenerative meniscal tears.”
However, in the trial there was a 32% crossover rate of patients undergoing delayed surgery after initial physical therapy mostly within the first year of the study. Noorduyn and her colleagues acknowledged “that not all patients experience satisfying results following physical therapy.”
Other experts agree with the Dutch study’s conclusion.
“Surgery has been descried as the ultimate placebo,” said orthopedic surgeons Brian Hallstrom and Ramzy Meremikwu, both of the University of Michigan in Ann Arbor. “Although there have been multiple randomized trials showing no efficacy of knee arthroscopy for knee arthritis or debridement of partial degenerative menisci, we are still studying these treatments, perhaps searching for a different outcome.”
The surgeons pointed out that surgery also comes with risks, is costly, and may actually accelerate the progression of knee osteoarthritis. The randomized ESCAPE trial collected data from nine orthopedic departments across hospitals in the Netherlands from 2013 to 2020. Out of the 321 initial participants aged 45 to 70, 278 completed the five-year-follow-up. Physical therapy and surgical groups shared the same baseline characteristics, says MedPage Today. Hallstrom and Meremikwu emphasized that the study shows again that “arthroscopy is not better than nonsurgical management of meniscal tears.”
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