Sham, Real PT Yield Similar Results for Meniscal Tear + OA

INCHEON, South Korea — A randomized controlled trial of physical therapy (PT) for pain relief in people with meniscal tear and osteoarthritis found no significant difference between sham and standard PT, but both showed slightly greater benefits than home-based exercise, according to a presentation at the World Congress on Osteoarthritis (OARSI) 2025 Annual Meeting.

The multisite Treatment of Meniscal Problems in OA (TeMPO) study enrolled 879 adults with meniscal tears and osteoarthritis, one third of whom were classified as having Kellgren-Lawrence grade 3 osteoarthritis. The participants, who had a mean age of 59 years, were randomly assigned to one of four arms: Self-administered, thrice-weekly, home-based strengthening exercises; the same home-based program but with biweekly motivational texts; the home-based exercises plus standard PT involving 12 visits over 3 months with a physical therapist; or home-based exercise plus a sham PT program that used zero energy ultrasound, as well as massage and manipulation distant from the knee joint.

At 3 months, all four groups showed around a 17- to 20-point reduction in their Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scores, with a 2- to 3-point greater reduction in the standard and sham PT arms compared with the home-based exercise-only arms.

“The primary outcome result of the trial is that we do not observe a clinically important or statistically significant difference,” study author Jeffrey N. Katz, MD, MS, professor of medicine and orthopedic surgery at Harvard Medical School and professor of epidemiology at Harvard T.H. Chan School of Public Health, both in Boston, told OARSI 2025 attendees.

At 6 and 12 months, the difference between the home-based exercises and the PT interventions had increased slightly to around a 4- to 6-point difference in KOOS pain scores, which was still below the minimum clinically important difference of 10 points. Participants in the sham and the standard PT groups had nearly identical KOOS pain scores.

Speaking to Medscape Medical News, Katz said while the researchers were surprised at the lack of difference in effect between the sham and standard PT, it suggested that the interaction with the physical therapist was clearly providing something meaningful for the patient.

“These are very interesting results that are helping people recognize what I think they already knew, which is the importance of the patient engagement,” Katz said. Patients were also more likely to develop a stronger relationship with their physical therapist because of the duration and frequency of consultations, he said. “They might have seen their physician once over the period of 12 physical therapy visits, so it’s a much deeper relationship, and it appears to be a valuable relationship.”

Katz also noted that while the intervention lasted only 3 months, the benefits accrued out to 12 months, suggesting that perhaps patients developed more accountability because of that relationship with the physical therapist.

Commenting on the findings, rheumatologist and epidemiologist Grace Hsiao-Wei Lo, MD, MS, associate professor in the Section of Immunology, Allergy, and Rheumatology at Baylor College of Medicine, Houston, said the results didn’t discount the benefits of PT. “I still think that there’s something that’s being offered, and we don’t know what the right physical therapy is for people who have meniscal tears,” she said to Medscape Medical News. “I worry about that, because I think if we start to say that physical therapy is not helpful compared to exercising at home, the insurance companies are going to stop covering it.”

Lo also noted that the control interventions of the home-based exercise programs weren’t themselves attention-neutral, although she was puzzled by the lack of effect of the text-messaging component.

The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Katz disclosed receiving grant support from NIAMS. Lo did not have any conflicts of interest to declare.