Degenerative Meniscus Tears - Should I Have Surgery?
Degenerative meniscus tears are a common cause of knee pain. Often, these injuries are treated through surgery. Specifically, arthroscopic meniscectomies are performed, where the surgeon enters the knee joint and removes the damaged part of the meniscus, keeping as much of the meniscus in tact as possible. Intuitively, that makes sense. If pain is arising from a tear in the meniscus, removing that tear should remove the symptoms. But recent research is throwing that view into question.
A 2013 study published in the New England Journal of Medicine looked at how effective these procedures really are. In this study, patients with degenerative meniscus tears were randomly assigned to receive either a partial meniscectomy, or a “sham” procedure where the surgeons would make the same incisions as a regular meniscectomy, but not actually remove any of the meniscus. Results showed significant improvement across all outcome measures in both groups, with no significant difference between the two groups.
Another recent study, in 2015, looked at exercise vs. surgery. In this study, patients were randomly assigned to receive either arthroscopic meniscectomy, or a 12 week exercise program. Again, both groups significantly improved functionally at 3, 12 and 24 month follow up, but again there was no significant difference between groups. In fact, the only significant difference between groups was that the exercise group was found to be stronger both at 3 month and 12 month follow up.
So, what should we take away from this new research? First of all, it is important to point out that these studies were looking at degenerative meniscal tears. This type of tear typically occurs in 35-65 year old patients, without major trauma. If you are a younger person, or have a significant trauma associated with your knee pain, arthroscopic surgery may still be indicated for you. However, if your knee pain came on more gradually, or with minimal trauma, the research suggests that arthroscopic surgery provides no more benefit than more non-invasive treatments.
If you are having knee pain, without significant trauma or injury, book in for an assessment. There is a good chance you will be able to improve your function, strength and pain without having to resort to surgery.