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SAVE THE MENISCUS
How Doctor’s Are Changing Their Approach to Treating Meniscal Tears
Surgery used to be the proposed gold standard of treating meniscal tears by orthopedic surgeons. Believe it or not, “Save the Meniscus” is a new slogan being used in the world of orthopedics to replace the old and outdated, “if it’s torn, take it out” philosophy relating to meniscal pathology.
The menisci are two fibrocartilaginous structures that sit inside of our knee joints. They help to absorb shock, improve joint stability, decrease joint contact stresses, and just help our knee joint move well. The menisci are extremely important in protecting knee joint health over time. They can tear secondary to a traumatic event such as a sports injury, or because of the aging process.
Fact or Fiction: a meniscal tear showing up on an MRI can be compared to having grey hair and wrinkles…. FACT!
Meniscal tears can occur at any age. Depending on the type of tear and your age, it is possible to continue being active even when diagnosed with one! Believe it or not, research has shown that with certain types of tears, especially degenerative tears, physical therapy provides results just as good, if not better than when surgery is performed! This is especially true in individuals who also have subsequent knee arthritis!
As per Doral et al, in many meniscal tear cases, it is recommended that surgeons should strive to not operate. This is especially true when improvements occur with conservative care. If an operation is recommended, it should emphasize the reparation, reconstruction, and preservation of tissue instead of removal.
For those who experience instability, locking, clicking, and a decreased quality of life after trialing conservative care such as physical therapy, surgery may be recommended. However, the typical prescription of 4-6 weeks of physical therapy may not suffice. Research shows that it can take three months to one year of conservative care for a meniscal injury to really feel better. If there is no improvement after an appropriate period of conservative care, the new recommended surgical actions may be in the form of a meniscal repair or replacement instead of a partial or full meniscectomy.
There is a lot of research out there refuting the need for surgery, especially in degenerative tears. As a friendly reminder, there are cases that surgery may be essential. These are the ones that impact your daily lifestyle and can cause possible other injuries (especially with an unstable knee). Please note, although I support the conservative care of meniscal injuries, I am not a surgeon. I read the research articles put forth by the medical community to take the best care of my patients. If you are looking for surgery regarding a meniscal tear, your doctor should help you make the best-informed decision regarding the appropriate option for you. And just a friendly reminder, if you have arthritis and have a meniscal surgery, your pain may not go away!
In conclusion, I think it is about time the narrative surrounding meniscal injuries changes. Why in the world would we want to remove large pieces of structures that help protect our knee joints (when not necessary)? For many years, the primary and recommended treatment option for a lot of meniscal tears whether traumatic or degenerative was surgery to remove the tattered part of the meniscal structure. Now, for some tears this may be the only option; however, if you or your physician have the choice, remember to try to save the meniscus.
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P.S. Professional athletes who have meniscal surgery are looking to return to the field as fast as possible. This does not necessarily mean that they will have better outcomes in the long run or decreased pain long-term. Just wanted to throw this into the mix for you to think about. ?