Why Meniscus Surgery Isn’t All It’s Cut Out To Be

Meniscus Surgery Operating Table

A Meniscus tear in your knee sounds pretty bad, doesn’t it? If you had a tear, your first thought, other than “Ouch!”, might be “I probably need surgery!” Well, you wouldn’t be alone. Arthroscopic partial meniscectomy is the most common orthopedic procedure performed in the United States – about 700,000 surgeries per year costing roughly 4 billion dollars1. Being so common, you would think the meniscus surgery must have incredibly successful outcomes, right?

Not so much…

Before we dig into the research, let’s brush up on our anatomy for a minute. Each of your knees has two menisci (I don’t think meniscuses is a word???). They are pieces of cartilage that act as a padding or cushion between your Femur and Tibia – bones of the thigh and shin.

A tear in the meniscus can occur acutely, often with a forceful twisting motion of the knee, or over time as a degenerative process.

Here’s how the arthroscopic partial meniscectomy is performed: by removing torn fragments of the meniscus and trimming it back in order to relieve symptoms2.

It makes sense on paper. Recent research, however, hasn’t fared in its favor.

Meniscus Surgery Outcomes – The Numbers Don’t Lie

There was a recent multicenter, randomized, double-blind, sham-controlled trial3 in 146 patients who had symptoms of degenerative medial meniscus tear and no knee Osteoarthritis (in other words – a really legit study was performed on a bunch of people with meniscus tears). Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. Outcomes in symptoms immediately after – and 12 months after – showed that the surgery group was no better than the sham group.

Do you know what sham means? It means that the surgery was simulated but not actually performed!

Think about that for a minute…

700,000 of these surgeries are performed each year…4 Billion dollars are spent…for no benefit.

For further proof, here’s some more research:

A recent randomized trial4 showed that arthroscopic partial meniscectomy combined with Physical Therapy provides no better relief of symptoms than Physical Therapy alone in patients with a meniscal tear and knee Osteoarthritis.

In the first research study I cited, patients only had the meniscus tear with no arthritis. This study included patients with both – and still the surgery provided no benefit.

I’m no surgeon, and I wouldn’t say I’m anti-surgery in many cases (although if not an emergency, I would say it should be a last resort after conservative treatment) – but I can say pretty confidently that I wouldn’t recommend having an arthroscopic partial meniscectomy, at least not before giving Physical Therapy a try.

What Physical Therapy Can Do for Your Knees

A meniscus tear isn’t benign. These studies aren’t showing that the tear isn’t something significant that shouldn’t be addressed – it comes with pain and other symptoms such as stiffness, swelling, and sometimes a locking sensation in the knee. However, these aren’t symptoms you have to live with the rest of your life.

Physical Therapy won’t heal a meniscal tear, but it can alleviate symptoms and, much more importantly, treat the impairments that may have led to the tear in the first place.

What kind of impairments?

Mobility, strength, and function.

  • Mobility of the ankle, knee, and hip joints along with flexibility of the muscles surrounding them is key
  • Strength in the muscles surrounding the knee – in areas of the calf, thigh, and hips – all of which provide stability for the knee joint, help relieve pressure on the meniscus
  • Function: how you perform certain movements can have a massive effect on the knee

The good news is: there are basic principles and tactics that can be taken to improve general mobility and strength for anyone, whether you currently have a torn meniscus, osteoarthritis of the knee, general aches and pains of the knee, or just want to prevent all of the above. To begin, I would recommend strengthening the Glute muscles to stabilize the leg. Here’s a video that will take you through a home exercise progression for Glute strengthening.

Even better than that would be to see a good Physical Therapist who will give you a full evaluation to identify impairments specific to you – then tailor a treatment program for you to follow.

I’ve Seen the Future, and It’s Bright

In my years as a Physical Therapist, I’ve treated thousands of patients with knee pain. Hundreds of those have had meniscus tears – some officially diagnosed, others not. Some have had the arthroscopic partial meniscectomy, others not.

My personal experience correlates with the research – outcomes for surgical and non-surgical patients with meniscus tears are similar. Physical Therapy for both groups has good outcomes. Proper treatment addressed toward specific impairments works.

Although meniscus surgery may not be beneficial, improving mobility, strength, and function is.

I’ve said it before, and I’ll say it again… Get Physical Therapy First!

Question: What can you do to improve your mobility, strength, and function? You can leave a comment by clicking here.

  1. Cullen, KA, Hall, MJ, Golosinskly, AAmbulatory surgery in the Unites States, 2006. Natl Health Stat Rep 2009; 11:1-25 ↩︎
  2. Sihvonen, et al. Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscus Tear, 2013. N Engl J Med 2013; 369:2515-2524 ↩︎
  3. Sihvonen, et al. Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscus Tear, 2013. N Engl J Med 2013; 369:2515-2524 ↩︎
  4. Katz, JN, Brophy, RH, Chaisson, CE, et al Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 2013; 368: 1675-1684 ↩︎
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