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Therapy often as good as surgery for knees, study finds


4 Star


Therapy often as good as surgery for knees, study finds

Our Review Summary

The story quoted two patients who had different treatment paths.  A quote from an editorial writer added a strong perspective.

(Disclosure:  The lead author, Dr. Jeffrey Katz, has reviewed stories for us on  He was not consulted by us about this study or about this story review.)


Why This Matters

The author of the editorial in the New England Journal of Medicine wrote: “millions of people are being exposed to potential risks associated with a treatment that may or may not offer specific benefit, and the costs are substantial.”

That’s why this is important and why that writer thought this study’s results should change medical practice.


Does the story adequately discuss the costs of the intervention?


The story included researcher estimates: “Surgery costs about $5,000, compared with $1,000 to $2,000 for a typical course of physical therapy.”

Does the story adequately quantify the benefits of the treatment/test/product/procedure?


This description of benefits observed in the study seems sufficient to us:

“After six months, both groups had similar rates of functional improvement. Pain scores also were similar.

Thirty percent of patients assigned to physical therapy wound up having surgery before the six months was up, often because they felt therapy wasn’t helping them. Yet they ended up the same as those who got surgery right away, as well as the rest of the physical therapy group who stuck with it and averted an operation.”

It would have been interesting to learn how much the patients improved from these injuries, and whether they regained total function or had lingering impairment.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story only quoted a commentary in the journal that published the paper – referring to “millions of people are being exposed to potential risks.”  But the specific risks weren’t qualified or quantified.

The paper itself reported:

“There were no significant between-group differences in the frequencies of overall or specific adverse events. Over the 12-month period of follow-up, serious adverse events occurred in 3 participants assigned to arthroscopic partial meniscec-tomy and 2 participants assigned to physical therapy alone (including one death in each group); adverse events rated as mild or moderate in severity occurred in 15 participants in the arthroscopic-partial-meniscectomy group and 13 participants in the physical-therapy group. Total knee replacement (coded not as an adverse event but rather as an indication for discontinuation from the study) was performed in 5 participants assigned to arthroscopic partial meniscectomy and 3 participants assigned to physical therapy alone.”

Does the story seem to grasp the quality of the evidence?


Adequate discussion:

“The new federally funded study compared surgery with a less drastic option. Researchers at seven major universities and orthopedic surgery centers around the U.S. assigned 351 people with arthritis and meniscus tears to get either surgery or physical therapy. The therapy was nine sessions on average plus exercises to do at home, which experts say is key to success.”

Ideally, the story might have touched on a few study limitations, such as the fact that only about a quarter of eligible patients agreed to be enrolled in the study. Patients who agree to be randomized to surgery or physical therapy in a study like this might be different in important ways from the average patient — and these differences might have affected the results.

Does the story commit disease-mongering?


There was no disease mongering of torn menisci.

Does the story use independent sources and identify conflicts of interest?


The story quoted two study leaders, an editorial author, and two patients.

Does the story compare the new approach with existing alternatives?


The focus of the story was a study comparing alternative treatment approaches.

Does the story establish the availability of the treatment/test/product/procedure?

Not Applicable

The availability of the various treatment approaches is not in question. The story could have cited stats from the study:

“This procedure, in which the surgeon trims the torn meniscus back to a stable rim, is performed for a range of indications in more than 465,000 persons annually in the United States.”

Does the story establish the true novelty of the approach?

Not Satisfactory

The story could have done a better job of explaining what was new and novel about the study in question.  The researchers wrote:

“(Two prior) landmark trials established that arthroscopic treatment was not superior to the other interventions in the treatment of knee osteoarthritis, but they did not focus on management of a symptomatic meniscal tear, which is a frequent indication for knee arthroscopy in patients with osteoarthritis of the knee. The efficacy of arthroscopic partial meniscectomy in symptomatic patients with a meniscal tear and osteoarthritis has been evaluated, to our knowledge, in only one randomized, controlled trial, which was a single-center study involving 90 patients. This study did not show a significant difference in pain relief or functional status between arthroscopic partial meniscectomy plus a physical-therapy regimen and physical therapy alone. Given the frequency and cost of arthroscopic partial meniscectomy and the paucity of data, we designed the Meniscal Tear in Osteoarthritis Research (METEOR) trial to assess the efficacy of arthroscopic partial meniscectomy as compared with a standardized physical-therapy regimen for symptomatic patients with a meniscal tear and concomitant mild-to-moderate osteoarthritis.”

Does the story appear to rely solely or largely on a news release?


It’s clear that the story did not rely on a news release.

Total Score: 7 of 9 Satisfactory


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