Physical Therapy and Home Exercise in Degenerative Meniscal Tear

Key Takeaways

• Investigators reported no meaningful 3-month KOOS Pain differences between home exercise alone and strategies that added text messages or standard physical therapy.
• Secondary function and performance outcomes were described as similar across groups, and later differences were presented cautiously.
• Adherence was reported as comparable across arms, arthroscopic partial meniscectomy occurred in a small minority over 12 months, and adverse events were rare and generally minor.

The trial compared four approaches built around the same home exercise program: home exercise alone; home exercise plus text messages; home exercise plus text messages plus standard physical therapy; and home exercise plus text messages plus sham physical therapy. The primary comparison asked whether these additions changed KOOS Pain over three months. Outcomes were reported as broadly similar across the exercise-based approaches at the prespecified 3-month assessment.

Researchers randomized 879 participants aged 45 to 85 years (mean age, 59.2 years). Baseline characteristics were described as similar across groups, supporting the planned comparisons. Eligibility required symptomatic knee pain, osteoarthritis, and an MRI-confirmed degenerative meniscal tear in the symptomatic compartment. Participants with Kellgren-Lawrence grade 4 radiographs were excluded. Assignment covered home exercise alone, home exercise plus text messages, home exercise plus text messages plus standard physical therapy, and home exercise plus text messages plus sham physical therapy, with each arm sharing the same home-program foundation.

The home program emphasized stretching and strengthening for the quadriceps, hamstrings, gastrocnemius, gluteus maximus, and gluteus medius. Instructional materials and ankle weights supported progression as participants advanced through the exercises. Standard physical therapy added therapist-directed exercise and manual therapy, while sham physical therapy provided a comparison clinic exposure without the same active elements. Across groups, the main differences were the added support and clinic contact layered onto the core home regimen.

At three months, the primary KOOS Pain comparisons were reported as not meaningfully different between home exercise alone and the groups that added text messaging or standard physical therapy. KOOS ADL and measured strength and performance tests were likewise described as not meaningfully different across arms. Small later differences were noted during follow-up, and the authors cautioned against treating those findings as definitive. Short-term pain and function outcomes were summarized as broadly similar across the randomized strategies.

Home-exercise adherence was tracked with biweekly logs, with adherence defined as exercising at least 3 days per week. Investigators reported similar adherence across arms, with 77% to 82% of weeks meeting that threshold. Attendance in the in-clinic physical therapy groups was also nearly identical during the intervention period. Over 12 months of follow-up, 80 participants underwent arthroscopic partial meniscectomy on the index knee, with similar arm-specific percentages. These measures suggested comparable exercise participation and later surgery rates across groups.

Adverse events were reported as rare and generally minor in the investigators' safety summaries. The authors reported one death and 33 hospitalizations during follow-up, and emergency department visits were described as uncommon. Those emergency visits were also noted to be evenly distributed across the randomized arms. Overall, the safety profile was reported as similar across approaches over follow-up.