Patient case (clinical description): A 66-year-old woman comes to the office due to joint pain in the hands and periodic morning stiffness that lasts less than 15 minutes.  The pain is moderately severe and worsens with daily activity. The patient used Tylenol with minimal relief.  Past medical history is notable for hypertension and hypercholesteremia.  Physical examination shows firm nodules over the distal interphalangeal joints, bilaterally. The patient has pain in her knees as well. The knees are stiff in the morning for less than 30 minutes and become worse with climbing stairs. She has some sensation of bone friction during activity. X-ray shows narrowing of the joint space, subchondral bone sclerosis and osteophyte formation along the joints.

Patient's own account: I'm a 66-year-old woman and I went to my doctor's office because of a bloody joint pain in my hands that has been lasting for a while. The pain comes and go in the morning usually. I feel like a stiffness that last less than 15 minutes. The pain is moderately severe but it gets worse when I'm using my hands. I used Tylenol which helped a little. Apart from that, I suffer from hypertension and high cholesterol. The doctor made me notice that I have bumps around both of my hand joints. I also suffer from my knees and they are also stiff in the morning for around 30 min. It's even worse when I climb up the stairs! I also feel like my bones are rubbing against each other when I'm moving. The X-ray showed that I have narrow joint space, I have sclerosis, and abnormal growths of bone along my joints.

Clinical trial: Comparing Knee Cartilage Surgery Versus Standard Physical Therapy in Treating People With a Meniscal Tear and Osteoarthritis

Eligibility criteria:
Inclusion Criteria:

          -  OA symptoms lasting at least 1 month and managed with medications, activity
             limitations, and/or physical therapy

          -  At least one symptom consistent with a torn meniscus. Symptoms may include clicking,
             catching, popping, giving way, pain with pivot or torque, episodic pain, and/or pain
             that is acute and localized to one joint line.

          -  Available knee X-ray (within 6 months) and MRI (within 3 years)

          -  Evidence of osteophyte formation or cartilage fissure, tear, or loss on a knee MRI OR
             plain radiographic evidence of osteophyte formation or joint space narrowing

          -  Evidence of a meniscal tear (tear extending to surface of meniscus) on a knee MRI

          -  Willingness to undergo random assignment and sign an informed consent

        Exclusion Criteria:

          -  Chronically locked knee

          -  Kellgren-Lawrence Grade IV status, indicating advanced OA and usually the need for
             total knee replacement

          -  Contraindication to MRI

          -  Radiographic chondrocalcinosis (a condition in which there are deposits of calcium
             pyrophosphate dihydrate [CPPD] crystals in one or more joints that eventually result
             in damage to the affected joints) AND acute symptomatic pseudogout

          -  Inflammatory diseases (e.g., rheumatoid arthritis, psoriatic arthritis, systemic lupus
             erythematosus, gout, pseudogout)

          -  Injection with viscosupplementation in the affected knee in the 4 weeks before study
             entry

          -  Any medical contraindications to surgery or physical therapy

          -  Both knees are symptomatic for meniscal tears and a candidate for bilateral APMs

          -  Prior surgery on an affected knee

          -  Pregnancy or possible pregnancy

          -  Claim filed for worker's compensation

          -  Unable or unwilling to give informed consent

          -  Unable or unwilling to attend physical therapy sessions at designated locations or in
             the community
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 45 Years old.


Eligibility (NLI label): Contradiction