Physical Therapy for Degenerative Meniscal Tear: No Added Benefit Over Home Exercise Alone in Knee Pain Management

Highlight

• Physical therapy and text message reminders did not significantly improve pain reduction compared to home exercise alone in patients with degenerative meniscal tear and knee pain.
• The study included 879 participants aged 45 to 85 years, randomized to four different groups involving home exercise, encouragement via texts, sham physical therapy, and standard physical therapy.
• The primary outcome measure was the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscore at 3 months, showing minimal between-group differences.
• Adverse events were generally mild and equally distributed among the groups, indicating safety regardless of intervention type.

Study Background

Degenerative meniscal tears are common in middle-aged and older adults and often associated with knee osteoarthritis, leading to pain and functional limitations. Physical therapy, encompassing strengthening, stretching, and manual therapies, is frequently recommended as a first-line treatment. However, the clinical efficacy of physical therapy over simple home-based exercise programs remains uncertain. This uncertainty poses challenges in optimizing resource utilization and providing evidence-based recommendations for managing degenerative meniscal tears and associated knee pain.

Study Design

This multicenter randomized controlled trial enrolled 879 participants aged 45 to 85 years, all presenting with knee pain, radiographic osteoarthritis, and MRI-confirmed meniscal tear. Participants were randomized into one of four groups:

• Home exercise program alone for 3 months.
• Home exercise plus text messages designed to encourage exercise adherence.
• Home exercise plus text messages plus sham physical therapy (including sham manual therapy and sham ultrasound therapy).
• Home exercise plus text messages plus standard physical therapy (supervised strength, functional and stretching exercises, and manual therapy).

The primary outcome was change in the KOOS pain subscore measured from baseline to 3 months, adjusted for trial site, baseline KOOS pain score, and radiographic osteoarthritis grade.

Key Findings

At 3 months, the mean differences in KOOS pain score changes were minimal:

• Between home exercise and home exercise plus text messages: -0.1 points (98.3% CI, -3.8 to 3.7), indicating no clinically meaningful benefit from text message reminders alone.
• Between home exercise and home exercise plus text messages plus standard physical therapy: 2.5 points (98.3% CI, -1.3 to 6.2), a small difference that did not reach statistical or clinical significance.
• Between home exercise plus text messages and home exercise plus text messages plus standard physical therapy: 2.5 points (98.3% CI, -1.4 to 6.5), also not statistically significant.

These findings suggest that neither additional encouragement via text messages nor supervised physical therapy provides meaningful added benefit in reducing knee pain beyond a structured home exercise program.

The adverse events reported during the trial were generally nonserious and evenly distributed across all groups, indicating that physical therapy interventions, including sham and standard approaches, were safe and well tolerated.

Expert Commentary

The trial challenges the widespread assumption that supervised physical therapy is superior to home exercise programs for managing degenerative meniscal tears and associated knee pain. The minimal benefit observed suggests that patient adherence to a simple home exercise regimen could be as effective as more resource-intensive interventions.

Limitations include the relatively short 3-month follow-up period; longer-term effects were not assessed and may differ. Additionally, participants were a heterogeneous group with osteoarthritis, which might dilute potential benefits in certain subpopulations. The sham physical therapy design helps control for placebo effects but may not fully replicate the experiential aspects of actual therapy.

The findings align with recent guideline recommendations emphasizing conservative management and cautioning against routine surgical or intensive therapy interventions unless clinically indicated. Future studies may explore patient-specific factors predicting better response to physical therapy or the role of adherence support strategies other than text messaging.

Conclusion

In patients aged 45 to 85 years with degenerative meniscal tears and knee pain, a structured home exercise program alone yields pain improvement comparable to programs supplemented with text message reminders or supervised physical therapy. Clinicians should consider patient preferences, access, and cost when recommending treatment strategies, emphasizing the feasibility and safety of home exercise interventions.

Funding and Trial Registration

This study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and other organizations. The trial is registered at ClinicalTrials.gov under the number NCT03059004.

Reference

Katz JN, Collins JE, Bisson L, Jones MH, Irrgang JJ, Selzer F, Safran-Norton CE, Spindler KP, Yang HY, Shrestha S, Bennell KL, Sullivan JK, Kluczynski MA, Arant K, Opare-Addo M, Huizinga JL, Zimmerman Z, Sople D, Tonsoline P, Kale M, Wind WM Jr, Chen AF, Freitas M, Lesniak B, Jordan K, Matzkin EG, Dawson C, Farrow L, Musahl V, Leddy JJ, Martin SD, Losina E. A Randomized Trial of Physical Therapy for Meniscal Tear and Knee Pain. N Engl J Med. 2025 Oct 30;393(17):1694-1703. doi: 10.1056/NEJMoa2503385. PMID: 41160820.