A Randomized Trial of Physical Therapy for Meniscal Tear and Knee Pain.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2026;14(2):24 N Engl J Med. 2025 01-Oct:. 10.1056/NEJMoa2503385What this means for my practice?
For patients with degenerative meniscal tear and knee pain, home exercise alone is as effective as more intensive or supervised physical therapy strategies for pain reduction. Clinically, this trial supports home-based exercise as a sufficient first-line treatment and challenges assumptions about the added value of in-clinic physical therapy in this population. Key limitations include limited racial and ethnic diversity and reliance on patient-reported pain outcomes.
Study Summary
879 participants with knee pain, osteoarthritis, and MRI-confirmed degenerative meniscal tear were randomized in this trial. Participants were assigned to home exercise alone, home exercise plus motivational text messages, home exercise plus motivational text messages plus sham physical therapy, or home exercise plus motivational text messages plus standard physical therapy. The primary outcome of interest was change in the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscore from baseline to 3 months. Outcomes were assessed at 3, 6, and 12 months. Overall, the results of the study revealed that none of the enhanced interventions provided clinically or statistically meaningful improvement in pain compared with home exercise alone, and that standard physical therapy was not superior to sham physical therapy, suggesting that contextual effects play a substantial role in observed improvements.
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