Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis
New England Journal of Medicine, 2013 · paper · Clinical trials
Studies whether arthroscopic partial meniscectomy gives better functional outcomes than nonoperative therapy for symptomatic patients with a meniscal tear and knee osteoarthritis. The text provided does not include the results.
2 findings
Substance Table 1 footnote ** reads 'a grade of 3 (≥50% joint-space narrowing) indicates moderate osteoarthritis, and a grade of 4 (>50% joint-space narrowing)', but the Methods define grade 3 as '<50% joint-space narrowing'.
- p. 14 Table 1 footnote **
a grade of 3 (≥50% joint-space narrowing) indicates moderate osteoarthritis, and a grade of 4 (>50% joint-space narrowing)
- p. 3 Enrollment and Randomization
Lawrence grade 3 [<50% joint-space narrowing]
- p. 14 Table 1 footnote **
a grade of 3 (≥50% joint-space narrowing) indicates moderate osteoarthritis
- p. 3 Enrollment and Randomization
Kellgren–Lawrence grade 3 [<50% joint-space narrowing]
Judge's note: The page 14 crop clearly shows '≥50%' for grade 3, and the page 3 crop shows 'Kellgren–Lawrence grade 3 [<50% joint-space narrowing]'. The footnote contradicts the Methods. It also overlaps its own grade 4 definition (>50%), and grade 4 patients were excluded (Fig. 1). Grade 3 should presumably read <50%.
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Wording Table 2 footnote § says 'Eight patients in the partial-meniscectomy group crossed over to surgery within 6 months'. These patients were assigned to surgery and crossed over by not having it.
- p. 15 Table 2 footnote §
Eight patients in the partial-meniscectomy group crossed over to surgery within 6 months, and 1 crossed over after 6 months.
- p. 15 Table 2 footnote §
Eight patients in the partial-meniscectomy group crossed over to surgery within 6 months
Judge's note: On the upright page 15 image the footnote is attached to the APM crossover cell 8/40. The text on page 6 and Fig. 1 say the APM-assigned crossovers are patients who 'had not undergone the procedure' / 'Did not undergo APM'. As printed, the footnote gives the direction of crossover backwards for this group.
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3 minor (typos and the like; most checked by the judge only)
Wording Fig. 2C numbers at risk ('PT, crossover <3 mo 26', 'crossover 3–6 mo 24', 'PT, crossover >6 mo 12') do not match the text and Fig. 1, which give 51 crossovers by 6 months and 'An additional 8 ... between 6 and 12 months' (59 in all).
- p. 12 Figure 2C, No. at Risk
PT, crossover >6 mo 12 11 11 10
- p. 6 Results, Outcomes para 2
An additional 8 active patients in the study (4.7%) who were assigned to the physical-therapy group crossed over to arthroscopic partial meniscectomy between 6 and 12 months.
- p. 12 Figure 2C, No. at Risk
PT, crossover >6 mo 12
- p. 6 Results, Outcomes paragraph 2
An additional 8 active patients in the study (4.7%) who were assigned to the physical-therapy group crossed over
Only the authors can say what is right here.
Judge's note: Page 12 image: in Fig. 2C the PT rows at baseline are 105 / 26 / 24 / 12, which sum to 167 (the PT baseline n in Fig. 2A). Text (page 6) and Fig. 1 (page 11): 51 crossovers by 6 months and 59 by 12 months. The 50 against 51 gap could come from baseline data being unavailable for 2 PT patients, but 12 patients crossing over after 6 months, 10 of them still at risk at 12 months, cannot be squared with 8 crossovers between 6 and 12 months. That holds unless the '>6 mo' group includes crossovers after 12 months, which the paper does not say. Only the authors can reconcile this.
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Wording Table 2 footnote § says 8 APM patients crossed over within 6 months 'and 1 crossed over after 6 months', while the text says '9 patients assigned to surgery (5.6%) had not undergone the procedure' by 6 months, and Fig. 1 gives '9 Did not undergo APM' at 6 months.
- p. 15 Table 2 footnote §
and 1 crossed over after 6 months
- p. 6 Results, Outcomes para 2
whereas 9 patients assigned to surgery (5.6%) had not undergone the procedure
- p. 11 Figure 1, APM arm 6-mo box
9 Did not undergo APM
Only the authors can say what is right here.
Judge's note: In Fig. 1 (page 11) the APM arm shows '9 Did not undergo APM' in both the 6-month and the 12-month boxes. The page 6 text gives 9 by 6 months. The Table 2 footnote (page 15) puts 1 of the 9 after 6 months. The ninth patient might be missing from the 6-month outcome table, but that would not make the crossover happen 'after 6 months'. The timing is inconsistent and the paper does not explain it.
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Wording Discussion: 'as compared with 44% of patients treated with physical therapy alone'. The 44% is 74/169 of all patients assigned to physical therapy, crossovers included.
- p. 7 Discussion, paragraph 3
as compared with 44% of patients treated with physical therapy alone
- p. 15 Table 2, Treatment success row
74 (44)
Judge's note: Table 2 (page 15) gives treatment success as 74 (44) with N = 169 for the PT group. The Results text on page 6 says '43.8% of patients assigned to the physical-therapy group'. Elsewhere the paper uses 'physical therapy alone' as the name of the arm ('assigned to physical therapy alone'), so this is loose wording rather than a different analysis. Still, 'treated with' suggests the denominator is patients who actually got only PT, and the same sentence says 'assigned to' for the APM figure.
Second check: another model agreed