Degenerative meniscus tears are very common. Many adults over 55 have one and will not know it. Surgery for degenerative meniscus tears is rarely necessary. Most research shows that people do just as well with physical therapy. This post will carry two messages, both equally important. First, surgery is rarely necessary for degenerative meniscus tears. Perhaps even more important is that once your knee feels better, and it may take several months, you should try to return to your normal activities.
Think about this second statement for a moment. If you had an episode of knee pain, and you had an MRI which revealed a degenerative tear; even though you now feel better you may not return to being active because you are afraid of harming your knee. Arthritis and other conditions worsen, even if you are at bed rest. Meniscus degeneration and tearing are no different. It is more of a biological issue than a mechanical issue. Meaning that you cannot stop the process, so you might as well remain active.
Why would you want to slow down your activities which are decreasing your risk of diabetes, obesity, dementia, hypertension, heart disease, and stroke? Rest comes with a heavy burden with respect to your overall health.
Recent research about degenerative meniscus tears and surgery:
The meniscus is a cushion inside your knee. It aids in the 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.
An 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 than 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.
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. Most of these changes we see in the meniscus we consider to be “age-appropriate.” We accept thinning hair, the need for glasses, slower running times, and so on… but none of us expect that our internal structures are showing signs of aging too.
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?
Many patients are under the assumption that because something is torn, therefore it 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 papers 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 removal of the torn flap will more than likely be necessary.
This was an important article about the management of this type of meniscus tear, but more studies are necessary. The take-home message is simply that all meniscus tears do not need surgery. Degenerative meniscus tears are usually managed well without surgery.
Have realistic goals about your recovery.
Very few of your orthopedic issues will resolve in less than 3 months. Many of you were told that if your pain persists for 4-6 weeks you should consider surgery. I would suggest that you wait longer than that. With 25 years of treating people under my belt, I can tell you that the majority of people were glad that they waited longer before moving forward with surgery. Surgery might actually bring you closer to a knee replacement. Surgery for degenerative tears will not decrease your chances of developing osteoarthritis. If you do choose to proceed with surgery for a degenerative meniscus tear it should be because:
- your pain persists after a lengthy period of non-surgical management,
- it was a quality of life decision…
- and your surgeon told you that you have little or no arthritis in your knee.
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 a few months later I think you’ll find that you’re glad that you did.