For many individuals who have a meniscus injury they are told surgery is the only option…but that is? If one takes time to look up the literature on this topic, it is not as conclusive as it may have been 2 decades ago. More and more data is showing that conservative care results in equally good outcomes.
How is that possible? That a person can be just as fine and active without surgery?
Well…for one, age-related changes happen and are often noted on imaging. There are a high number of individuals (especially > 40 yrs old) with “meniscal tears” who have no symptoms at all (Zanetti). Thus all meniscal changes on imaging do not necessarily mean much in terms of function.
Next surgery and conservative care (Physical Therapy) have been studied. And guess what? Patient outcomes at 6 months and 2 years were nearly identical (Kahn, Katz). That’s right. People with confirmed meniscal tears who went through a rehab program recovered just as well as those who had surgery. This suggests conservative care should be the 1st line of treatment for any suspected meniscal issue, and probably even before any time or money is spend on imaging. Because remember plenty of individuals with meniscal tears DO NOT have any symptoms
Still not convinced? They even studied real surgery vs fake surgery. Guess what…the result were identical (Sihvonen). Thus, meniscal surgery is not all its cracked up to be.
So…what should be the best plan of action?
For any person who is concerned about a meniscal issue, a thorough physical examination should be conducted (no imaging necessary immediately). Assuming the professional clears any major findings, AT LEAST 6 weeks of structured physical therapy should be completed. This is not a here’s a piece of paper with some exercises – go do them kind of thing. Everyone needs skilled eyes on the problem here to adjust and progress on the fly as appropriate. Only after lack of success with conservative care or a regression in status should imaging be considered. Even then careful consideration of the next steps should be taken and not just jump into surgery as some injuries do take more time to heal.
There you have it…surgery is not necessarily necessary for a meniscus injury. Concerned about your knee(s) or someone else’s? Want to know more about treatment options?
If so then fill out this QUICK FORM asking for further consultation via phone. Then if it is a match, the next best steps can be discussed.
Zanetti et al. Patients with Suspected Meniscal Tears: Prevalence of Abnormalities Seen on MRI of 100 Symptomatic and 100 Contralateral Asymptomatic Knee. 2003:181;635-641.
Kahn et al. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ 2014. DOI:10.1503 /cmaj.140433
Katz et al. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. N Engl J Med 2013;368:1675-84. DOI: 10.1056/NEJMoa1301408
Sihvonen et al. Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. N Engl J Med 2013; 369:2515-2524 DOI: 10.1056/NEJMoa1305189