Many people seek alternatives to meniscus surgery. This interest is fueled by significant and controversial research indicating that meniscus surgery may not only fail to help some people, but in certain cases, it could leave patients in a worse condition. For those who have been told that surgery is the only solution for their knee problems, the research outlined in this article may help them understand that more options exist beyond surgical intervention.

Potential Long-Term Effects of Meniscectomy

The research presented suggests that meniscectomy surgery can result in long-term instability of the knee. The joints, including the knee, rely on the gliding surface of articular cartilage that covers the ends of the bones inside the joint for smooth movement. Specifically, the cartilage covers the top of the tibia and the bottom of the femur, with the meniscus providing cushioning between these bones.

The Role of the Meniscus

The meniscus, or menisci, are thick, strong, cartilage-like structures that act as shock absorbers. They cushion and support the knee by sitting between the thigh bone (femur) and the shin bone (tibia). Each meniscus is shaped like the letter “C” and is essential for stabilizing the knee as it bears the body’s weight and allows the bones to glide smoothly through the joint’s full range of motion. Meniscus problems can arise from traumatic injury, aging, or general wear and tear. Such wear and tear is common in athletes and individuals whose jobs involve significant physical activity and knee stress.

Common Causes of Meniscus Injuries

In sports, meniscus injuries frequently occur due to impact or sharp movements, such as cutting or turning, which can trap the meniscus between the femur and tibia. These injuries are often accompanied by ligament damage, particularly to the Medial Collateral Ligament (MCL). One of the most severe knee injuries, known as “O’Donoghue’s Triad,” involves a lateral blow to the outside of the knee. This type of injury, common in football when a player’s knee is struck by another player rolling against it, can simultaneously cause tears to the Anterior Cruciate Ligament (ACL), the MCL, and the meniscus.

The Consequences of Tissue Removal in the Knee

Removing tissue from the knee, particularly the meniscus or knee cartilage, can have significant long-term consequences. When tissue is taken out, it ultimately weakens the knee and increases the likelihood of developing arthritis over time. This is a common reason why many individuals undergo multiple surgeries on their knees—often attempting to address issues that were, in part, a result of earlier tissue removal.

Current Surgical Practices and Patient Experiences

Despite advances in medical understanding, some physicians still believe that the meniscus cannot be repaired—either through the body’s natural healing processes or with surgical intervention. As a result, they may opt to shave, smooth, or partially remove the damaged meniscus. Over time, it is not uncommon to encounter patients who have undergone several arthroscopic surgeries on the same knee. Some even take pride in the number of surgeries they’ve had, but this sentiment often changes when they learn that repeated surgeries can hasten the need for a knee replacement. Moreover, the range of motion after a knee replacement is limited, which can restrict a person’s ability to engage in the activities or work that once contributed to their meniscus issues.

Potential for Meniscus Regrowth and Conservative Treatments

A frequently asked question is whether there is any treatment available that can regrow meniscus tissue. The answer is yes, but with important limitations. Treatments such as orthobiologics—including platelet rich plasma and stem cell therapy—can aid in repairing a damaged meniscus. However, these therapies cannot restore the meniscus if it has been completely removed; they can only assist in healing tissue that is still present. Alongside these options, other conservative care treatments are available and are discussed in the following sections.

Some people have inquired about the possibility of using biological 3D cellular printing to create a new meniscus. While this technology is promising and exciting, it remains many years away from practical use.

Overview of Meniscus Tears in Middle-Aged Patients

In middle-aged individuals, a diagnosis of meniscus tear often leads to arthroscopic partial meniscectomy (APM). However, there is growing evidence that this surgical procedure may offer little or no benefit for this patient group. Degenerative meniscal lesions typically occur in middle-aged or elderly patients without any history of significant acute trauma. Research published in January 2022 (1) indicates that the prevalence of these lesions increases with age and that they are frequently associated with knee osteoarthritis. These lesions can both cause and be caused by osteoarthritis of the knee.

Current Treatment Practices and Recommendations

The most common orthopedic intervention for degenerative meniscal lesions is arthroscopic partial meniscectomy. Several randomized controlled trials advise against using arthroscopic partial meniscectomy as the first-line treatment for degenerative meniscal lesions. The recommendation is to reserve arthroscopic partial meniscectomy for cases where conservative therapy has failed after three months, or to consider it earlier only in patients with significant mechanical symptoms of the knee.

Recent Evidence from Systematic Review and Meta-Analysis

A systematic review and meta-analysis published in January 2023 (2) examined data from previously published studies comparing arthroscopic partial meniscectomy to non-surgical or sham interventions in patients with MRI-confirmed degenerative meniscus tears. The average age of patients in these studies was approximately 55 years, with 52% being women. The primary outcomes assessed were knee pain, overall knee function, and health-related quality of life, measured at 24 months follow-up. At 24 months follow-up, the group undergoing arthroscopic partial meniscectomy showed a small improvement in knee pain compared to the non-surgical or sham group. However, there were no differences between the two groups in terms of overall knee function or health-related quality of life. Furthermore, the analysis did not identify any relevant subgroup of patients who benefitted more from arthroscopic partial meniscectomy than from sham surgery.

A paper published in September 2022 (3) evaluated the functional outcomes and pain scores in patients undergoing either exercise therapy or arthroscopic surgery for degenerative meniscal lesions. The authors highlighted that previous studies generally found little advantage of surgical intervention over conservative management for most patients. Conservative treatment, particularly physical therapy, is recommended as the first-line approach.

References

1 Akkawi I, Draghetti M, Zmerly H. Degenerative meniscal lesions: Conservative versus surgical management. Acta Bio Medica: Atenei Parmensis. 2022;92(6).
2 Wijn SR, Hannink G, Østerås H, Risberg MA, Roos EM, Hare KB, van de Graaf VA, Poolman RW, Ahn HW, Seon JK, Englund M. Arthroscopic partial meniscectomy versus non-surgical or sham treatment in patients with MRI-confirmed degenerative meniscus tears: a systematic review and meta-analysis with individual participant data from 605 randomised patients. Osteoarthritis and Cartilage. 2023 Jan 13.
3 Rotini M, Papalia G, Setaro N, Luciani P, Marinelli M, Specchia N, Gigante A. Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews. Musculoskeletal surgery.