When Is Conservative Treatment Better? Nearly Always, for Some Patients with Chronic Orthopedic Pain

In 2014, investigations have called into question the need for arthroscopy for degenerative meniscal tears and have suggested that epidural injections for cervical radiculopathy and lumbar spinal stenosis offer little benefit.

In a Finnish trial, 150 patients with nontraumatic meniscal tears and knee pain were randomized to arthroscopy or to sham arthroscopy, followed by a graduated exercise program for all. At 12 months, both groups showed similar improvement in knee pain (NEJM JW Gen Med Jan 28 2014). This outcome reinforced the results of a 2013 randomized trial in which patients with meniscal tears and osteoarthritis did not benefit more from arthroscopic repair than from physical therapy alone (NEJM JW Gen Med Mar 28 2013). In addition,…