Research summary

U.S. Multicenter Trial Finds No Added Pain Benefit from In-Clinic Physical Therapy Over Home Exercise for Degenerative Meniscal Tear

Edited by:
Ashton L. Stahl

Key Highlights

  • At 3 months, no clinically meaningful differences in Knee Injury and Osteoarthritis Outcome Score pain change between groups.
  • Sham and standard in-clinic physical therapy produced nearly identical pain trajectories through 12 months.
  • Adverse events were uncommon and similar across groups; ~9% underwent arthroscopic partial meniscectomy within 12 months.

Researchers who developed the largest-to-date randomized evaluation of physical therapy (PT) strategies for knee pain associated with degenerative meniscal tear report that adding in-clinic PT or adherence-prompting text messages to a home-exercise regimen did not yield superior pain reduction at 3 months. The study, published October 29, 2025, in The New England Journal of Medicine, enrolled US participants aged 45–85 years with osteoarthritis and MRI-confirmed meniscal tears.

For the 4-group randomized, controlled trial, known as the TeMPO trial, Katz and colleagues randomly assigned patients to: (1) home exercise, (2) home exercise plus thrice-weekly text messages, (3) home exercise + texts + sham PT, or (4) home exercise + texts + standard PT (manual therapy plus supervised strengthening/functional work). All groups were prescribed 100 minutes of exercise weekly for 12 weeks. The primary outcome was change in the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscore (0–100; higher = worse) from baseline to 3 months, adjusted for site, baseline KOOS pain, and radiographic grade. Prespecified comparisons used Bonferroni-corrected thresholds; secondary outcomes included treatment failure and durability, functional tests, and quality of life.

Study Findings

A total of 879 participants (mean age 59.2±7.8 years) were randomized across 4 US centers, with balanced baseline characteristics. Primary analyses showed no meaningful between-group differences at 3 months. The change in KOOS pain differed by −0.1 points (98.3% CI, −3.8 to 3.7) for home exercise vs home exercise + texts; 2.5 points (98.3% CI, −1.3 to 6.2) for home exercise vs home exercise + texts + standard PT; and 2.5 points (98.3% CI, −1.4 to 6.5) for home exercise + texts vs home exercise + texts + standard PT.

Secondary outcomes were consistent. Treatment failure at 3 months occurred in 36.2% (home), 31.6% (home + texts), 29.5% (home + texts + sham PT), and 34.8% (home + texts + standard PT). Among 409 participants without failure at 3 months and with 12-month data, durability was achieved by 77.3%, 80.7%, 78.4%, and 88.7%, respectively. KOOS and functional measures improved similarly across groups, and sham and standard PT yielded nearly identical trajectories at all time points. An adjusted difference favoring standard PT at 6 months (4.1 points; 95% CI, 0.7 to 7.6) and 12 months (2.5 points; 95% CI, −1.2 to 6.2) arose in secondary analyses without multiplicity adjustment.

Adherence was high and comparable (mean adherent weeks 76–82% across groups). Serious adverse events were uncommon and similar by arm; 1 death occurred in the standard PT group. Over 12 months, 9.1% underwent arthroscopic partial meniscectomy, with similar rates (8.2–9.6%) across arms.

Clinical Implications

According to the study authors, the findings suggest that, for patients with degenerative meniscal tears and osteoarthritis, adding in-clinic standard PT or adherence-oriented text messaging to a structured home-exercise program does not confer superior 3-month pain relief. The authors note that sham and standard PT produced nearly identical outcomes, that motivational texts did not improve adherence or pain, and that any small differences observed at later time points arose from secondary analyses without multiplicity adjustment. Reported limitations include underrepresentation of some racial/ethnic groups, participant awareness of intervention type, and generalizability outside the specific regimens and session lengths studied.

Expert Commentary

“Our intent was to compare home exercise with added therapist interaction and to separate contextual effects from plausible biomechanical benefits; across 12 months, changes with sham and standard in-clinic physical therapy were virtually identical, and adding these elements did not reduce pain more than home exercise alone at 3 months,” the researchers concluded.

Reference

Katz JN, Collins JE, Bisson L, et al. A randomized trial of physical therapy for meniscal tear and knee pain. N Engl J Med. 2025;393(17):1694-1703. doi:10.1056/NEJMoa2503385.