For the purpose of this post we will focus solely on the fibrous cartilage, the meniscus.  Its role within the knee is to act as a cushion (shock absorber) between the thigh bone and the shin bones.  It is built and designed to withstand huge amounts of compressive force which enables us to go about our daily lives in the way we do, walking running, etc…  And when issues arise in this structure we are often presented with painful experiences.

There are two types of issues that arise within the meniscus.  We have the degenerative and we have the torn (usually from a traumatic event) meniscus.  Both present very differently but the general principle surrounding them both is basically the same.

The treatment of both consist of either surgical intervention or conservative management.  Whilst there are justifications for both, it is vital we understand what and why we do either so we are best prepared to make informed and smart decisions.  If you opt for surgical intervention, the surgeon usually shaves away part of the meniscus, this is known as a menisectomy.  The shaving of the meniscus allows a smoother glide in the knee joint and therefore is believed to reduce pain.  However, the risks associated with this are that you now have less of a shock absorbing material within the knee joint area so activity may become limited if you don’t want to see a gradual deterioration of the knee joint.

The other option is meniscus repair.  Many surgeons are now opting for this as a result of the issues caused over the past few years with faster degeneration of joints due to less meniscus present.  However, the older we get, as with anything, the slower our bodies are at healing so in some instances it may not be a great option due to timeframes to heal sufficiently.  It is also worth noting that rehabilitation from meniscus repair is usually 6 months on average whereas menisectomy is often 6-8 weeks of rehab.

One thing I often explain to patients I see with these conditions is that the meniscus, as with pretty much everything in your body, is adaptable and able to heal (in certain parts of the meniscus) given the right care and treatment.  I have seen many patients who have done really well with conservative management and got back to full fitness/activity with meniscus tears but I have also seen patients who have tried the rehabilitation conservatively and failed and had to have an operation to stabilise the joint area before resuming their rehabilitation with me and getting back to full fitness.  The key here is to have a clear understanding of your condition and situation so that you can make the correct decisions that work best for you in the long run.  I often spend many consultations speaking with patients about all the things they can expect to happen, which is supported and backed up by evidence.  There are many cases too where what I tell the patent is not exactly what they wished to hear (such as conservative management is not going to help here and surgery has to be their first point of call).

Whichever pathway you choose though, the rehabilitation after is key.  From a personal perspective, I would always opt for the conservative pathway first.  That is not a bias stand point, it is actually one supported by ample evidence.  My main concern for my own knee is that the evidence suggests and invasive surgery to the knee joint creates a higher risk of secondary issues forming in later life (such as early onset of arthritis) so I am always keen to avoid any instruments being used to ‘fix’ an issue’  This is however a personal choice, and each and every one of us need to be able to make our own decisions on the best pathway forwards but we cannot do this until we have all the facts about what we can expect.

To expect a clear, simple and straight forward pathway with either of these options (surgery or conservative) when we have either a degenerative or acute meniscus injury is more than likely unrealistic and will usually have many set backs on the way (regardless of option choice).  My belief though is in the importance of understanding the situation as best you can so that you can make the best choices possible for you and your body.