Meniscus Tears in the knee – Is surgery a good idea?

The meniscus are two key parts of the knee that protect the cartilage in your knee joint. They are located between the surfaces of the femur (your thigh bone) and tibia (your shin bone) in each knee They protect bones by acting as shock absorbers during movement.  A meniscal tear is a very common diagnosis and ‘key-hole’ surgery as well as open surgery is one of the most common surgical procedures carried out worldwide. Arthroscopic Partial Meniscectomy (key hole surgery) is the most frequent surgical procedure performed by orthopaedic surgeons in the United States, with more than 50% of the procedures performed in patients 45 years of age or older. The issue with this type of surgical procedure though is that your chances of developing Osteoarthritis in the knee dramatically increase as seen in this study and this study  which is one of the most common causes of musculoskeletal disability in developed countries

MRI is often the main tool used to diagnose damage to the meniscus and clinicians often use this finding as a key reason as to why someone should under-go surgery.  However, studies are showing that the causation of pain may not actually be related to the meniscus tear and furthermore, those who do have surgery on this part of the knee are actually at an increased risk of developing arthritis as a result.

In a recent study, the finding of meniscus tears in men aged 50 to 59 years old was 32% and 19% in women respectively.   Whereas findings were 56% for men and 51% for women respectively, among those 70 to 90 years of age. Men had a higher prevalence of meniscal tears in all age groups, but women had a higher prevalence of meniscal destruction in the oldest age category.

One thing of note in this study was that those who has a meniscus tear also had a much higher chance of having arthritis in the joint area anyway.  This opens up the possibility of ‘is the arthritis the cause of the pain or is it the tear’?  Furthermore, it has been shown that

“Surgical resection of damaged parts of the meniscus is unlikely to reduce pain substantively in patients in whom osteoarthritis is causing or contributing to the symptoms, and evidence is lacking to support the approach of meniscal resection, as compared with nonsurgical treatment, in these patients”

In another study, which involved U.S. veterans, most of whom were men, meniscal tears were noted in 37 of 49 control subjects without knee pain (mean age, 67 years) who were seeking health care for another condition.  This again goes to show that meniscul tears are not always the causation of the pain felt in the knee.  These 37 veterans had a meniscul tear but had no pain on movement.  They were not aware they had a tear!

In addition, other reports of MRI findings, including studies of contralateral knees (assessment of both knees in one person) among patients with knee injury, have suggested that a meniscal tear of the knee among persons who do not have symptoms is more common than previously thought.  Again, meniscul tears were found on people who have no symptoms at all.

What is of importance is the age in which these meniscul tears have been found.  Middle-aged onwards tends to be a highly sensitive time for the human body to sustain meniscul tears/damage.  This is also the time when you would expect Osteoarthritis to set in on humans (as in you would not be surprised).  When it comes to the younger population, meniscul tears are most likely caused by acute trauma and therefore would need a slightly different approach but that is not to say that surgery would be the go to choice here.  From research and speaking with highly regarded professionals in the area of knee surgery, it has been suggested that of all those going for knee surgery currently, only about 1% of those actually need it.  The need for surgery lies when there is a mechanical issue such as ‘locked knee’ and the subject cannot fully extend their knee.  This is the only case which we have been made aware of that would require surgery.

So to conclude, the knee is a very robust piece of equipment.  It can undergo huge amounts of force and stress and not be affected.  MRI scans have their place, but when you have that knee pain and you are seeking advice from your GP, who then agrees to send you for a scan, and it comes back with a ‘torn meniscus’, please, please, please, ensure you consider what has been said here.  Any form of surgery disrupts the biological make-up of the human body and by opting for surgery over conservative management (exercise based treatment) you could be fast tracking yourself to early degeneration and Osteoarthritis of the knee.

The words here are supported by various studies but also are the views of myself as a therapist.  You should always seek further advice when making decisions for surgery and other medical procedures.

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