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Degenerative meniscal tears often coexist with knee osteoarthritis, making it difficult to know whether symptoms are driven by the meniscus itself or the broader joint disease. The MeTeOR randomized trial compared arthroscopic partial meniscectomy followed by physical therapy with a standardized physical-therapy strategy in adults with mild-to-moderate osteoarthritis and a degenerative meniscal tear. In the intention-to-treat analysis, improvements in pain and function were similar between groups at the main follow-up point. Some patients assigned to physical therapy later crossed over to surgery, but the presence of a possible future operation did not mean that immediate arthroscopy was necessary for everyone. The trial therefore supports a stepwise approach in which a well-designed exercise and rehabilitation programme is considered before surgery for many patients with this clinical profile. The findings do not say that arthroscopy has no role; patients with persistent symptoms despite adequate nonoperative treatment may still undergo surgery. Rather, they challenge the assumption that imaging evidence of a degenerative meniscal tear automatically justifies arthroscopic intervention. For HCPs, the key practical message is to align treatment with symptoms, functional limitations and the osteoarthritic context, using physiotherapy as an active therapeutic strategy rather than a passive delay before surgery.
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Degenerative meniscal tears often coexist with knee osteoarthritis, making it difficult to know whether symptoms are driven by the meniscus itself or the broader joint disease. The MeTeOR randomized trial compared arthroscopic partial meniscectomy followed by physical therapy with a standardized physical-therapy strategy in adults with mild-to-moderate osteoarthritis and a degenerative meniscal tear. In the intention-to-treat analysis, improvements in pain and function were similar between groups at the main follow-up point. Some patients assigned to physical therapy later crossed over to surgery, but the presence of a possible future operation did not mean that immediate arthroscopy was necessary for everyone. The trial therefore supports a stepwise approach in which a well-designed exercise and rehabilitation programme is considered before surgery for many patients with this clinical profile. The findings do not say that arthroscopy has no role; patients with persistent symptoms despite adequate nonoperative treatment may still undergo surgery. Rather, they challenge the assumption that imaging evidence of a degenerative meniscal tear automatically justifies arthroscopic intervention. For HCPs, the key practical message is to align treatment with symptoms, functional limitations and the osteoarthritic context, using physiotherapy as an active therapeutic strategy rather than a passive delay before surgery.
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