Post by beebs on Apr 5, 2013 5:43:09 GMT -5
An article published in the The New England Journal of Medicine show arhroscopy for suffers of osteoarthritis and meniscal tear lacking effectiveness. Anecdotal: all those I know who suffered had surgery for their musculoskeletal issues, torn ligaments, cartilage, etc. did not improve.
Likewise, I read some papers published about the lack of effectiveness about physiotherapy. To date, I know no one who benefited from physiotherapy. It makes no sense, to further stress inflamed tissues, bones, joints, cartilage, nerves etc..
Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis
Jeffrey N. Katz, M.D., Robert H. Brophy, M.D., Christine E. Chaisson, M.P.H., Leigh de Chaves, P.T., O.C.S., Brian J. Cole, M.D., M.B.A., Diane L. Dahm, M.D., Laurel A. Donnell-Fink, M.P.H., Ali Guermazi, M.D., Ph.D., Amanda K. Haas, M.A., Morgan H. Jones, M.D., M.P.H., Bruce A. Levy, M.D., Lisa A. Mandl, M.D., M.P.H., Scott D. Martin, M.D., Robert G. Marx, M.D., Anthony Miniaci, M.D., Matthew J. Matava, M.D., Joseph Palmisano, M.P.H., Emily K. Reinke, Ph.D., Brian E. Richardson, P.T., M.S., S.C.S., C.S.C.S., Benjamin N. Rome, B.A., Clare E. Safran-Norton, P.T., Ph.D., O.C.S., Debra J. Skoniecki, M.S.N., A.N.P., Daniel H. Solomon, M.D., M.P.H., Matthew V. Smith, M.D., Kurt P. Spindler, M.D., Michael J. Stuart, M.D., John Wright, M.D., Rick W. Wright, M.D., and Elena Losina, Ph.D.
March 19, 2013DOI: 10.1056/NEJMoa1301408
Background
Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain.
Full Text of Background...
Methods
We conducted a multicenter, randomized, controlled trial involving symptomatic patients 45 years of age or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. We randomly assigned 351 patients to surgery and postoperative physical therapy or to a standardized physical-therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). The patients were evaluated at 6 and 12 months. The primary outcome was the difference between the groups with respect to the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score (ranging from 0 to 100, with higher scores indicating more severe symptoms) 6 months after randomization.
Full Text of Methods...
Results
In the intention-to-treat analysis, the mean improvement in the WOMAC score after 6 months was 20.9 points (95% confidence interval [CI], 17.9 to 23.9) in the surgical group and 18.5 (95% CI, 15.6 to 21.5) in the physical-therapy group (mean difference, 2.4 points; 95% CI, −1.8 to 6.5). At 6 months, 51 active participants in the study who were assigned to physical therapy alone (30%) had undergone surgery, and 9 patients assigned to surgery (6%) had not undergone surgery. The results at 12 months were similar to those at 6 months. The frequency of adverse events did not differ significantly between the groups.
Full Text of Results...
Conclusions
In the intention-to-treat analysis, we did not find significant differences between the study groups in functional improvement 6 months after randomization; however, 30% of the patients who were assigned to physical therapy alone underwent surgery within 6 months. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases; METEOR ClinicalTrials.gov number, NCT00597012.)
www.nejm.org/doi/full/10.1056/NEJMoa1301408?query=featured_surgery