I read this article, today, about the comparison of successful outcomes for people with knee injuries who had surgery vs. physical therapy. It's pretty interesting and something we've been saying to people for a very long (20 years) time.
"You might not want to rush into knee surgery. Physical therapy can be just as good for a common injury and at far less cost and risk, the most rigorous study to compare these treatments concludes. Therapy didn't always help and some people wound up having surgery for the problem, called a torn meniscus. But those who stuck with therapy had improved as much six months and one year later as those who had arthroscopic surgery right away, researchers found."
"Both are very good choices. It would be quite reasonable to try physical therapy first because the chances are quite good that you'll do quite well," said one study leader, Dr. Jeffrey Katz, a joint specialist at Brigham and Women's Hospital and Harvard Medical School. He was to discuss the study Tuesday at an American Academy of Orthopaedic Surgeons conference in Chicago. Results were published online by the New England Journal of Medicine.
A meniscus is one of the crescent-shaped cartilage discs that cushion the knee. About one-third of people over 50 have a tear in one, and arthritis makes this more likely. Usually the tear doesn't cause symptoms but it can be painful. When that happens, it's difficult to tell if the pain is from the tear or the arthritis — or whether surgery is needed or will help. Knee surgery for a torn meniscus is done about half a million times each year in the U.S.
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. After six months, both groups had similar rates of functional improvement. Pain scores also were similar."
"There are patients who would like to get better in a 'fix me' approach" and surgery may be best for them," said Elena Losina, another study leader from Brigham and Women's Hospital.
However, an Australian preventive medicine expert contends that the study's results should change practice. Therapy "is a reasonable first strategy, with surgery reserved for the minority who don't have improvement," Rachelle Buchbinder of Monash University in Melbourne wrote in a commentary in the medical journal. As it is now, "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," she wrote. Surgery costs about $5,000, compared with $1,000 to $2,000 for a typical course of physical therapy, Katz said.
We have found, in our practice, that people who are athletes do very well with physical therapy for extremity injuries. However, non-athletes and people over 40 typically do not do nearly as well with PT as they do with the integrative therapy that we offer in our office. We have treated many patients in the latter category who have been unsuccessful using PT for injured knees and shoulders, who have completely recovered after treatment with us.
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