Torn Medial Meniscus: Knee Surgery vs. Physical Therapy

As a former sufferer from medial meniscus tear related pain and limitations, I took a special interest in this piece. It's been a decade since my sports injury and subsequent knee surgery. Ten years ago I was a scared, nervous, overwhelmed patient and today I'm luckily in a position where I can educate and help those who are now in the position I was back then. Pretty cool stuff. So let's get into it, shall we?

To cut or not to cut

The age old question is always in front of us whenever we experience a serious knee injury. When you move too quickly and feel a "snap." When you slip and fall and hear a "pop." When a sharp, sudden pain turns into bruising and swelling. The first question that comes to mind is always, "Am I going to need surgery to fix this?" Your brain goes a million miles per second. You're thinking about the operation day. You're wondering if you're healthy enough for surgery. You wonder how long the recovery is going to take. Are you going to need time off from work? Are you going to lose an entire season of hiking or skiing? You run...well, limp... to your computer and quickly hit the internet searching for symptoms, statistics and second opinions. And then, when all hope seems lost, you stumble upon this wonderful new article published in the New England Journal of Medicine. It turns out you might not need surgery at all! Whew! But first, let's talk more about meniscus tears.

Injuries vs. Arthritis

Your meniscus consists of two discs of cartilage that sit next to each other in between your upper leg (femur) and lower leg (tibia) bones, acting as a buffer and shock absorber for your knees. The discs are found inside the knee joint and are fixated to the bone. That's why sometimes when we accidentally over-stretch, bend, or twist the knee, the cartilage can be torn with a great enough force. The most commonly seen knee injury is a medial meniscus tear, or a tear of the disc on the inner side of our knee. Conversely, the general wear and tear that occurs to a joint over time can also contribute to a degenerative process that may lead to a meniscus tear as well. This well-known process is called osteoarthritis, or simply arthritis.

How can you be sure it's a torn meniscus?

The most common symptoms of a torn meniscus are: stiffness and swelling in the knee, pain and tenderness along the joint line or general knee pain, swelling in and around the knee, and a "catching" or "locking" sensation in the knee. Depending on your age, level of activity, severity of meniscus tear, or failed conservative treatment options (i.e. physical therapy), surgery may be recommended. A commonly performed procedure to alleviate symptoms from a torn meniscus is called a meniscectomy. Translation = a surgical removal of a part of the meniscus. Many times this is the knee-jerk reaction (no pun intended...thanks, but I'm not that funny) to a meniscus tear. "Trim up" or "clean up" the torn or frayed edges and you'll be good as new. But for many people, this may not be your only option.

Now what was all that talk again, something about not needing surgery or something like that?

Physical Therapy has long been considered the go-to remedy for post-surgical meniscus repair rehabilitation. Physical therapy works on strengthening muscle imbalances in the lower extremity, correcting postural alignments and improving balance and stability by analyzing the way you perform certain movements and helping you perform them more efficiently and safely. But according to recent research, by doing all those things instead of having surgery, there's a really good chance you might end up just as well as if you actually had meniscus surgery and then followed up with the physical therapy rehabilitation you'd have been prescribed anyway. Exciting stuff, eh?

OK, OK, we get it, no surgery is great, but why are you writing an entire article about it?

Well, first off, I'll point out the obvious. Any time you can avoid surgery and preserve the natural integrity of a joint the better. I mean, who wants their knee to hurt every time it's going to rain, am I right? Eh? Eh? Kidding aside, now more than ever it's important for you as recipients of health care to have efficient, evidence-based treatments that 1) get you better, and 2) are cost-effective. Physical therapy is much friendlier on the wallet than surgery, and as health care costs rise and benefits are tough to come by, it's important to know that you're getting the greatest bang for your buck and getting the quickest recovery possible.

So does this mean no meniscus surgeries will ever be performed again and if you injure or tear your meniscus physical therapy alone is a guarantee cure? Of course not. Every injury is different and every body heals differently. But what it does mean is that research is telling you that you have a much better fighting chance than originally thought with more conservative treatment, and that is some really good news!

For more information on medial meniscus tears in the knee, signs and symptoms, or specific physical therapy exercises to perform to help prevent a medial meniscus tear or rehab from a current injury, please contact us and we'd love to help discuss it with you.

References:

1st image from theknee.com

2nd image from health.harvard.ed