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Comment & Response
February 26, 2019

Arthroscopic Partial Meniscectomy vs Physical Therapy for Nonobstructive Meniscal Tears

Author Affiliations
  • 1Inselspital University Hospital, University of Bern, Bern, Switzerland
JAMA. 2019;321(8):805-806. doi:10.1001/jama.2018.20261

To the Editor I would like to address some issues in the study on the effect of early surgery vs physical therapy (PT) on knee function among patients with nonobstructive meniscal tears.1

First, patients with “knee pain and a nonobstructive (ie, no locking of the knee joint) meniscal tear confirmed by magnetic resonance imaging (MRI)”1 were eligible for randomization to arthroscopic partial meniscectomy (APM) or PT. No mention is made of history or physical examination findings. Meniscal tears are common in the general population but are of limited diagnostic value. For example, the prevalence of a meniscal tear on MRI ranged from 19% to 56% in a random sample of people living in Framingham, Massachusetts, and 61% of these people did not have any knee symptoms.2 Therefore, the inclusion criteria in the study by van de Graaf and colleagues for the ESCAPE Research Group1 are typically not regarded as an indication for surgery. In a letter to the editor commenting on a study with similar inclusion criteria, the author stated: “No reputable knee surgeon would operate on patients based on these criteria. We have known for a long time that these types of changes on MRI scanning are often an incidental finding. Unless closely tied in with symptoms and signs, these findings are irrelevant.”3