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 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.
Current research 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.
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.
Diagnosing Meniscus Tears
Imaging techniques, such as MRI and musculoskeletal ultrasound, often reveal meniscus tears, particularly in active individuals over the age of 30 or 40. Degenerative tears, characterized by frayed fibers, are common but rarely cause symptoms. It is important to recognize that simply identifying a meniscus tear on imaging does not necessarily mean it is the source of knee pain. Overemphasizing these findings can lead to unnecessary interventions.
Ultimately, the question remains: what should be done when a meniscus tear is discovered? Careful consideration of symptoms and clinical findings is crucial, as not all meniscus tears require surgical treatment.
One significant study frequently referenced was published in 2017, when the effectiveness of meniscus surgeries was still under debate. At the time, millions of these procedures were performed each year. this is when the British Medical Journal released clinical practice guidelines titled “Arthroscopic Surgery for Degenerative Knee Arthritis and Meniscal Tears: A Clinical Practice Guideline.”(1) These guidelines were developed after reviewing extensive research on the real benefits of arthroscopic surgeries for degenerative knee disease and meniscus tears.
Arthroscopic surgery involves inserting a small camera, roughly the size of a pencil, into the knee through multiple incisions. The procedure allows surgeons to inspect the joint and trim damaged meniscus tissue. While these “cleanout” surgeries are very common, many patients did not experience meaningful improvement following the procedure.
The guidelines reached a strong conclusion: surgery should not be performed for degenerative knee disease, including arthritis and small meniscus tears. There is no significant long-term benefit compared to non-surgical options. The advantages of surgery are typically short-lived, and any perceived benefit may be due to the placebo effect, which accounts for about 30%. In reality, fewer than 30% of patients achieve lasting benefit from these procedures.
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.
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 (2) 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.
Recent Evidence from Systematic Review and Meta-Analysis
A systematic review and meta-analysis published in January 2023 (3) 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 (4) 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 Siemieniuk RA, Harris IA, Agoritsas T, Poolman RW, Brignardello-Petersen R, Van de Velde S, Buchbinder R, Englund M, Lytvyn L, Quinlan C, Helsingen L. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. Bmj. 2017 May 10;357.
2 Akkawi I, Draghetti M, Zmerly H. Degenerative meniscal lesions: Conservative versus surgical management. Acta Bio Medica: Atenei Parmensis. 2022;92(6).
3 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.
4 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.
