Meniscus Surgery? Think Twice!

Background

The knee is a tremendously important joint in our body, and its health is crucial to performing essentially any lower body task: walking, running, jumping, squatting, stair climbing, etc.

One of the structures that helps to absorb/distribute the force that comes into our knee joint with various activities is the meniscus.

The meniscus is a C-shaped ring of specialized cartilage tissue in the knee that is easily visualized; see the picture below, where it is to be noted that we have two menisci in the knee – a medial and a lateral.

Once again, the meniscus is an important component of our knee that helps to protect the underlying bone and promote smooth movement.

Unfortunately, it is not uncommon for the meniscus to experience various injuries as we age: a number of different tears can befall the meniscus.

It might seem that if this structure is torn, the solution is clear: surgically correct or remove the tear. However, as often in the world of orthopedic medicine, things are not always so black and white.

An increasing amount of evidence suggests that surgically correcting or removing the torn meniscus is no better than leaving it alone and pursuing a course of conservative care (i.e., physical therapy treatment).

Study: “Increased Joint Space Narrowing After Arthroscopic Partial Meniscectomy: Data From the Osteoarthritis Initiative.” American Journal of Sports Medicine, 2022.

The study being reviewed here suggests that not only is surgically correcting the torn meniscus a non-superior course of care, it may even be detrimental to the long term health of the knee.

The authors compared three groups of people: those with meniscus tears who went on to have surgery, those with meniscus tears who did not have surgery, and those without meniscus tears at all.

The authors wanted to see what would happen to the knee ‘joint space width’ between these three groups.

The knee joint space width is the amount of space between the two primary bones of the knee joint: the femur (our thigh bone) and the tibia (our shin bone). The joint space width is a measure of the amount and health of the cartilage that helps to protect the underlying bone: under normal circumstances, the more joint space width, the better.

Normal joint space = good Loss of joint space = bad

Here I will quote the authors results: “We found that patients having a meniscal tear and undergoing APM (meniscus surgery) had approximately a 27-fold greater decline in JSW (joint space width) in the first 12 months after surgery compared with patients who did not have surgery, and there were no differences between the nonsurgical knees with and without a meniscal tear.”

To summarize, undergoing meniscus surgery led to significantly greater joint space width narrowing – a worse outcome for the knee, reflecting knee cartilage loss – compared to knees that did not undergo surgery, whether or not they had a meniscus tear.

Application

Are you or someone you know experiencing knee pain that a healthcare provider has told you is due to a meniscus tear? Are you considering surgical intervention?

This study, in addition to numerous other recent publications, cautions against such an approach.

Instead of pursuing surgery, a course of (well designed!) physical therapy may assist you in resolving your knee pain. I would be more than happy to help where I can; please do not hesitate to contact me or go ahead and click ‘schedule appointment’ at the top or bottom of the page to schedule your completely free first visit!