Degenerative meniscus tears are very common. Many adults over 55 have one and will not know it. Degenerative meniscus tear surgery is rarely necessary. Most research shows that people do just as well with physical therapy.
One of the most common knee problems an Orthopedist sees in the office is a degenerative meniscus tear. A meniscus is a cushion inside your knee. It aids in stability of the knee and minimizing the stress across the knee, thus minimizing the risk of developing osteoarthritis.
Meniscus tears are incredibly common. Although meniscus tears occur in all age groups, they are most common in adults over 55. There are many different types of meniscus tears. By far the most common tear is a degenerative tear of the posterior horn of the medial meniscus.
A recent article published in the New England Journal of Medicine out of Finland studied patients with degenerative meniscus tears. They studied whether the results of an arthroscopy (surgery) was better then a sham surgery (where the patient is brought to the operating room and thinks they had the surgery).
As published in the NY Times, The authors found …
A popular surgical procedure [arthroscopy] worked no better than fake operations in helping people with one type of common knee problem [degenerative meniscus tear], suggesting that thousands of people may be undergoing unnecessary surgery.
The Wall Street Journal posted a similar article , and led off by saying…
A fake surgical procedure is just as good as real surgery at reducing pain and other symptoms in some patients suffering from torn knee cartilage
These findings are not new.. but in this environment perhaps they will shine a light on the over-treatment of degenerative meniscus tears. In 2007 a study showed that the results from an arthroscopy for a degenerative meniscus tear were not superior to a supervised exercise program.
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What is a degenerative meniscus tear
Degenerative tears occur because as we age, or because of our genetics — our tissues simply wear out over time. A degenerative tear is frayed, worn out tissue that looks like the worn out area on the front of your blue jeans. It has very little character, and the tissue is thin, soft, flexible and looks worn out when we view it at the time of surgery.
For many many years I have spoken to people about the fact that many meniscus tears, especially degenerative meniscus tears do not often require surgery.
Do I Need Surgery For a Degenerative Meniscus Tear?
One of my most popular videos on YouTube is about this very same subject.
Many patients are under the assumption that because something is torn, it therefore must be fixed. That is not the case for many issues in Orthopedic Surgery. This paper on the non-surgical management of degenerative meniscus tears versus surgical management is yet another in a series of paper that supports the non-surgical management of degenerative meniscus tears, especially in the setting of osteoarthritis. Despite how severe your pain is at the onset of your symptoms, typically within a few weeks your knee feels much better if managed by physical therapy, ice, heat and anti-inflammatory medication (if you tolerate it).
It must be pointed out. The authors of the paper studied degenerative meniscus tears. They did not study the more unusual “radial”, “flap”, or “bucket-handle” tears that can occur in the meniscus. These other tears can be far more “unstable” and produce mechanical symptoms such as instability, buckling and giving way. In those instances, a meniscal repair, or a removal of the torn flap will more than likely be necessary.
This is an important paper, but far more study is necessary. The take home message is simply that all meniscus tears do not need surgery. Degenerative meniscus tears are usually managed well without surgery. When your visit with your doctor be sure to ask what type of tear you have. If you possess a degenerative tear, without any of the mechanical symptoms we mentioned — you should pursue non-surgical treatment at first and I think you’ll find that you’re glad that you did.
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