October 2025: A Randomized Trial of Physical Therapy for Meniscal Tear and Knee Pain
The issue
For adults 45–85 with knee pain, osteoarthritis, and a degenerative meniscal tear, adding clinic-based physical therapy or motivational text messages did not reduce pain more than a well-structured home-exercise program alone over 3 months. Pain and function improved substantially in all groups.
What do I need to know?
In the TeMPO randomized trial (n=879), participants were assigned to one of four approaches: (1) home exercise; (2) home exercise + text messages; (3) home exercise + texts + sham PT; or (4) home exercise + texts + standard PT. The primary outcome was change in KOOS-Pain (0–100; higher = worse) at 3 months. Differences between home exercise and either standard PT or texts were small (~2–3 points) and not clinically meaningful. Adherence to home exercise was high across groups, and adverse events were infrequent and similar. Secondary analyses suggested a possible small advantage for standard PT at 6 months, but these were not definitive. Overall, a clear, progressive home program (stretching and strengthening for quadriceps, hamstrings, gluteals, calf) was as effective as adding clinic PT or nudging texts for short-term pain relief.
Potential risk of persistent knee pain (early symptoms, no prior structured program)
Recommended Actions
Start a progressive home-exercise regimen (about 100 minutes/week) that strengthens quadriceps, hamstrings, and gluteals and includes flexibility work.
Track pain and function (KOOS-style questions) weekly and progress resistance (ankle weights or bands) as tolerated.
Consider simple reminders (calendar/phone) if consistency is a challenge, but understand texts alone don’t add pain benefit beyond doing the exercises. NEJMoa2503385
Imminent risk of ongoing limitations (several months of pain despite basic exercises)
Recommended Actions
Review your form and progression with a clinician or PT once or twice to individualize the home plan; prioritize adherence and graded load rather than frequent clinic visits.
Add performance goals (e.g., 30-second sit-to-stand count, 40-meter walk time) to guide progression; reassess every 4–6 weeks.
Reserve injections or arthroscopy for clear mechanical symptoms or failure of a well-executed exercise program.
Confirmed significant impairment (pain limiting walking/ADLs, considering surgery)
Recommended Actions
Commit to a 12-week structured home program with progressive strengthening and functional drills; short, targeted PT visits can fine-tune technique but aren’t required for pain benefit.
Use objective checkpoints (KOOS-Pain ≥8-point improvement target) at 3 and 6 months to judge success before escalating care.
If surgery is still on the table after a high-adherence program, discuss risks/benefits given that many patients improve without it.
What can I do?
Ask your clinician or PT: “Can you set me up with a progressive home plan and milestones so I know I’m improving?” Keep a simple log (minutes exercised, sets/reps, pain before/after, weekly function tests). Progress gradually (heavier bands/weights, more challenging functional exercises) as pain allows. If you hit a plateau, a brief PT check-in can adjust form and load—then return to consistent home work, which this trial shows is usually enough.
