Degenerative meniscus tears, part of the aging process, are the most common reason for knee arthroscopy because many primary care physicians and orthopedic surgeons believe that meniscus tears always require surgery. “This is not the case,” says Rodney Benner, MD, an orthopedic surgeon at Shelbourne Knee Center. “Many degenerative meniscus tears will get better without surgery. Because we deal with knee problems all the time, we’re uniquely positioned to tease out factors that make it more or less likely that surgery will be effective.”
Meniscus Tears and Arthritis
Many meniscus tears do not cause pain or other symptoms and are only diagnosed during evaluation for another knee problem. “About 30% of people over the age of 40 who think they have a normal knee find out they have an abnormal meniscus when they have an X-ray,” says Dr. Benner.
If X-rays show knee osteoarthritis, it’s difficult to determine whether symptoms are from this or a meniscus tear. Arthroscopic surgery won’t relieve knee osteoarthritis. “It’s become clear over the last few decades that arthroscopic surgery for arthritis does not work and should not be done, even if the patient has a meniscus tear,” says Dr. Benner.
Non-Surgical Treatments Work
Even when the patient has symptoms, the initial treatment for degenerative meniscus tears should be nonsurgical. Recommendations from an evidence-based, expert consensus statement on the treatment of degenerative meniscus tears back this up. Published in Arthroscopy: The Journal of Arthroscopic & Related Surgery (February 2020), the panel of experts who wrote the statement included K. Donald Shelbourne, MD, an orthopedic surgeon at Shelbourne Knee Center.
Most older patients with meniscus tears can obtain relief from symptoms such as pain, swelling and decreased range of motion, and improve function, without surgery. Shelbourne Knee Center recommends activity modification and rest, medications, injections and/or physical therapy as the initial treatment(s).
The order in which treatments are provided depends on the severity of the symptoms and the patient’s preferences. “We engage in shared decision-making to figure out what will work best,” says Dr. Benner.
If the patient seems to be getting better, over-the-counter medications and rest allow a gradual transition back into normal activity. Some patients need a short course of steroids or prescription anti-inflammatory medication, followed by physical therapy. A steroid injection is a good option for pain severe enough for the patient to be considering surgery. “If the knee injection helps temporarily but the pain comes back, that’s a good indication that surgery will probably help the patient,” says Dr. Benner.
Physical Therapy Heals Most Meniscus Tears
Research data from Shelbourne Knee Center show that about 80% of all meniscus tears will get better with appropriate physical therapy.(1) Medications or a steroid injection can be given to relieve pain enough for the patient to participate in physical therapy.
At Shelbourne Knee Center, physical therapy for meniscus tears focuses on:
- Preventing or eliminating swelling
- Regaining full range of motion
- Strengthening the leg
- Restoring normal walking.
With the guidance of one of Shelbourne Knee Center’s physical therapists or athletic trainers, patients complete most exercises at home and come into the office for a few visits.
Surgery as the Last Resort
Surgery is the last resort for a degenerative meniscus tear, says Dr. Benner. If meniscal repair does become necessary, doing physical therapy first helps ensure a better result and a faster recovery.
Shelbourne Knee Center research shows that restricting weight-bearing for six weeks after surgery isn’t necessary.(2) Restoring full range of motion and allowing weight bearing helps patients recover faster. Post-op physical therapy is designed to:
- Control swelling
- Restore knee extension and flexion
- Improve knee strength.
For more information about treatment for degenerative meniscus tears at Shelbourne Knee Center, call 888-FIX-KNEE or email skckneecare@ecommunity.com.
References
1. Shelbourne Knee Center research data. Accessed 6/2/20.
2. Shelbourne KD, Patel DV, Adsit WS, Porter DA. Rehabilitation After Meniscal Repair. Clinical Sports Medicine. 1996 Jul;15(3):595-612. Accessed 6/2/20.