Knee Injury--The PT Alternative
Last month, my mom, who is 67, had surgery on a torn meniscus in her right knee. She's not even sure how she tore her meniscus, and it was a very light tear; could have been something as simple as planting her foot wrong or her foot coming lose from her shoe, causing the twist. I wouldn't consider her particularly "active;" she has a full-time desk job but does walk for about 20 minutes a day at lunch when weather permits.
Before her surgery, I did some investigating on whether surgery was necessary, and what she could expect to be able to do once her treatment was complete. I asked her if her doctor had suggested physical therapy as an option, rather than the surgery. She was told the surgery, done in an outpatient office, was very non-invasive and with some rest and proper pampering of her knee, she'd be fine in a few weeks. And she now is, having recently returned to work. Other than the exercises she was told to do every day after she got home, she was told post-op physical therapy would not be needed.
It turned out that her surgeon removed some arthritic cartilage too, so perhaps the surgical intervention was the best option, in her case. But it did make me wonder if physical therapy was even put forth as a viable alternative to having the surgery. Perhaps the doctor took a look at the tear and decided surgery would be minimal enough to go right to the source. And when my mother first experienced the tear, she was in a great deal of pain; at the outset the combination of the tear and arthritis formed in the knee made walking near to impossible.
New research from Brigham and Women's Hospital (BWH), suggests that physical therapy may prove just as effective as surgery for some patients. These findings were presented this month at the annual meeting of the American Academy of Orthopedic Surgeons and simultaneously published online in the New England Journal of Medicine.
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.
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. The research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.
Should my mom have been encouraged to opt for physical therapy rather than the surgery? It might have saved her time off from work, but would it have prolonged her pain when walking? Can patients assume doctors do consider PT as an option, but decide on a patient-by-patient basis who needs surgery and who can heal just as well without it? I'd be interested to know what readers think.