The meniscus is the cushion inside the knee joint. It can degenerate over time, causing tearing that results in pain and limited motion. As we age, this can combine with underlying arthritis to cause debilitating symptoms and often patients with the combination are offered surgery as a solution to their symptoms.
Unfortunately, surgery does not always result in a cure, and it is often recommended that physical therapy be tried first.
Given this controversy, the latest study in the New England Journal of Medicine is very helpful, in that it showed:
Physical Therapy, instead of surgery, as the first treatment choice in patients with meniscus tear & some mild/moderate arthritis, works as well as surgery. This avoids surgery in many patients who will not require it, but those who remain with symptoms, despite waiting 6 months, do benefit from surgery and do require that intervention.
More and more studies will be done over the coming years to demonstrate the benefits of less invasive and less costly therapies as there is a greater need for an understanding of the best conservative approaches to conditions that are currently imperfectly treated by the standard methods of care. Of course, there is no information on whether this is actually a less costly approach, given the duration of therapy, the need for physical therapy, and the delay in resolution of symptoms (which has a cost unto itself.)
Still, it is nice to know that a conservative approach is a reasonable one in this common combination of conditions.