Project status: Active, enrolling new subjects

Knee pain and meniscal tears are highly prevalent in persons 45 years old and older, and are associated with substantial disability and medical costs among. While the recommendation to initiate PT for persons ≥45 years old with knee pain and meniscal tear rests on strong evidence, there is little therapeutic guidance for patients whose pain persists despite initial PT. Determining if nonoperative alternatives are more effective than APM for patients who have not benefited from a standard regimen of physical therapy and home exercises may help patients and their clinicians choose the most effective treatments when initial non-surgical therapy has not resolved symptoms.

The COSMIC (Conservative care Or Surgery for Meniscal tear after Initial Clinic-based physical therapy: Patient preferences) study is a pilot study designed to help prepare for a prospective randomized control trail (RCT). The trial will compare the effectiveness of APM vs. enhanced nonoperative therapy in persons who have failed PT for degenerative meniscal tears and osteoarthritis (OA). COSMIC aims to develop a strategy for identifying and contacting eligible subjects and estimating the number of eligible patients who would agree to participate in the prospective RCT if it existed. COSMIC data will also shed light on factors associated with willingness to enroll in the RCT.

The COSMIC study is led by Dr. Jeffery N. Katz, MD, MSc, along with a team of investigators from Brigham and Women’s Hospital (BWH) and the University at Buffalo. This study is supported by grant #5R34AR082021-02 from the NIH NIAMS. Enrollment started at the University at Buffalo and the Brigham in August 2023.