Is Surgery The Best Route For Meniscus Tears?

So last time I talked about what a meniscus is, it's role in the knee, the types of injuries that can occur to it and the way it can be injured. In this article I am going to give you the what to do about an injured/damaged meniscus.

A highly debated topic regarding knee meniscus injuries and a question I am commonly presented with in clinic once I diagnose a meniscus injury is “what is the best option for recovery?”

The out dated view on such question would be ‘treatment can’t do anything I’ll write you a referral and see you on the other side of the surgery table’ - how times are changing. 

To reiterate the importance of the meniscus to the knee, it’s a major stabilising component for the knee and takes a lot of the load when we are weight bearing, whether that be walking, jumping, hopping or running we need the meniscus to take the pressure off the articular cartilage covering the bone ends. Top of shin bone (tibia) on the bottom of thigh bone (femur) would be quite painful – such cleverly designed human anatomy decided to place a big wedge of cartilage in to help.

The down side to this wedge of cartilage is that it has a low blood supply which why previously surgery was seen as the best route for recovery. The idea was to reduce painful symptoms by cutting out any worn edges to regain the smooth horse-shoe type shape and only then rehabilitation would kick in getting the muscles to stabilise the joint and take it through load management.

Realistically all that was happening was that cartilage was being shaved off and having even less cartilage left in the knee which was putting a greater emphasis on the muscles to support the joint to reduce the symptoms, it began to become apparent – why do we need the middle man (surgery)?

Oh How Times Have Changed!

Although the approach of surgery has changed from “if it’s torn, take it out” to “preserve the meniscus” due to the early onset of Osteoarthritis being found, recent studies have suggested no benefit for having surgery against conservative treatment alone. 

Short term the surgical procedures may improve symptoms but it makes sense that Osteoarthritis was kicking in earlier in people who had surgical procedures, as explained before about the increase in pressure in the knee joint with the less meniscus present, “wear and tear” occurs in the knee quicker. 

Good Quality Rehab Is The Way Forward

Long term solutions or management is always at the forefront of any musculoskeletal condition that I treat. With meniscus injuries if you go through a specific knee and hip strengthening rehabilitation programme it adds a lot of support to the meniscus and can decrease symptoms with no surgical knife in sight. 

What great news I hear you say. Just think no risky surgery, no hospital stays, no anaesthetic and no painful scars.

Of course, there are certain situations where surgery cannot be avoided and any good therapist will be able to recognise these cases and make the appropriate referral.

If a conservative approach isn’t making a dent to your symptoms/pain because of the size or location of the tear surgery could be something to consider. Age is another factor to consider as younger people are more likely to respond better to surgery due to amount of cartilage and muscle strength they tend to have around the knee.

My Final Thoughts

The final thing to consider is the activity levels you want to get back to. With any meniscus clients I see I set the expectation level due to all of the above factors and we work together to get them back to doing what they love.

The one message I want you to takeaway from this if I haven’t painted the picture already is to definitely try a conservative approach FIRST before you even consider surgery and don’t let anyone convince you that surgery is always the best option as often it is not necessary.

For more tips like this to help ease pain and stiffness in your knee visit here: www.wdcphysio.wpenginepowered.com/physiotherapy/knee-pain – to get your free copy of my knee pain report which reveals 7 simple ways to end it to help get you exercising again.