Degenerative meniscus tears are the most common reason for knee arthroscopy, yet whether these tears benefit from surgery is controversial, according to an evidence-based, expert consensus statement on the treatment of degenerative meniscus tear published in Arthroscopy: The Journal of Arthroscopic & Related Surgery (February 2020).1 K. Donald Shelbourne, MD, an orthopedic surgeon at Shelbourne Knee Center, was one of 20 international experts who provided input on the consensus statement.
Many degenerative meniscus tears are asymptomatic and are only diagnosed during evaluation for another knee problem. Whether symptomatic or asymptomatic, initial—and usually the only—treatment for degenerative meniscus tears at Shelbourne Knee Center is conservative, as the consensus statement recommends.
“Up of 75% of knee arthroscopies are performed because the patient is over 40 and the X-ray isn’t bad enough for total knee arthroplasty,” says Dr. Shelbourne. “These procedures are unnecessary. These patients just need proper therapy.”
Conservative Treatment Works
Most patients with symptomatic degenerative meniscus tears obtain relief without surgery. Physical therapy is the mainstay of treatment at Shelbourne Knee Center. Research data from Shelbourne Knee Center show that about 80% of all meniscus tears will become asymptomatic with appropriate physical therapy.2 Medications or a steroid injection can be given to relieve pain enough for the patient to participate in physical therapy.
Shelbourne Knee Center’s physical therapy protocol 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 the center’s nine physical therapists and athletic trainers, patients complete most exercises at home. They come into the office for a few visits.
Other initial treatments include activity modification and rest, medications and steroid injections. The order of treatments 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 Rodney Benner, MD, an orthopedic surgeon at Shelbourne Knee Center.
Surgery as the Last Resort
Surgery is the last resort for a degenerative meniscus tear. “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,” says Dr. Benner. For example, if an injection helps temporarily but the pain recurs, this is a good indication that surgery is likely to be effective.
If meniscal repair does become necessary, preoperative physical therapy helps ensure a better outcome and a faster recovery. Shelbourne Knee Center research shows that restricting weight-bearing for six weeks after surgery isn’t necessary.3 Restoring full range of motion and allowing weight bearing helps patients recover faster. Postoperative physical therapy is designed to:
- Control swelling
- Restore knee extension and flexion
- Improve knee strength.
“We focus on the optimal treatment for each individual. If surgery is the best option, our research-backed process ensures the best outcome,” says Dr. Shelbourne.
References
- Hohmann, Angelo, Arciero, Bach, et al. Degenerative Meniscus Lesions: An Expert Consensus Statement Using the Modified Delphi Technique. Arthroscopy: J Arthroscopic & Rel Surg. February 2020: 36(2): 501-512
- Shelbourne Knee Center research data. Accessed 11/5/20.
- Shelbourne KD, Patel DV, Adsit WS, Porter DA. Rehabilitation After Meniscal Repair. Clin Sports Med. 1996 Jul;15(3):595-612. Accessed 6/2/20.