Meniscus Injury: Surgery vs. Physical Therapy

A meniscus injury is a prevalent source of knee pain. Many young athletes are at an increased risk of a meniscus tear as injuries often result from motions that typically occur during sports mobility such as twisting, cutting, and pivoting. However, meniscal tears may also result from regular, degenerative changes that occur with increased age. According to the American Academy of Orthopedic Surgeons, “anyone at any age can tear a meniscus.”

Treatment for meniscal injuries depends on the type, size, and location of the tear as well as age and activity level of the injured individual.

Traditionally, the RICE protocol is the first method of intervention for knee injuries. This protocol includes relative rest, ice, elevation, and compression. Your doctor would likely recommend starting regular usage of non-steroidal anti-inflammatories (NSAIDs) to reduce inflammation and swelling during this phase of recovery.

Physical therapy is attempted for a few weeks to promote a safe and pain-free return to the prior level of function. If symptoms persist, then surgical intervention is typically pursued.

A meniscectomy is a very common arthroscopic procedure in which the doctor inserts a miniature video camera through a small incision (portal) into the knee joint.

This camera provides the surgeon with proper visibility inside the knee to properly diagnose and treat the affected areas of the meniscus. Surgical instruments are also inserted through small knee portals and allow for proper trimming, removal, and repair of the torn tissue. Length of recovery varies depending on the complexity of surgical intervention; rehabilitation time ranges from 1-3 months.

High success and high satisfaction rates after surgical intervention have been reported in the literature. However, recent evidence shows that conservative treatment may be equally as effective as invasive, surgical approaches especially for those with degenerative meniscal tears.

The New England Journal of Medicine (NJEM) released a research article that reported: “the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.” This means the individuals that received a surgical simulation, as opposed to an actual meniscectomy, showed no difference in pain or quality of life 12 months later.

Another NJEM study compared outcomes of different treatment options for people with a meniscus tear and knee osteoarthritis. One group had as arthroscopic partial meniscectomy and received post-operative physical therapy.

The other group participated in physical therapy intervention alone. Similar improvements in functional status and pain were noted for both groups at a 12 month follow-up. Even those individuals that were given an opportunity to switch from conservative treatment to surgical intervention “reported similar outcomes as those who initially had surgery.”

The British Journal of Medicine published research that reported “no relevant difference found” in pain, quality of life, or level of disability between physical therapy intervention and arthroscopic partial meniscectomy for 2 years. However, an increase in lower extremity strength was found only in the physical therapy group within the first 3 months.

The effectiveness of conservative treatment for degenerative meniscal injuries is consistently documented in the research. Improvements in pain and quality of life are frequently observed even without the need for surgical intervention. Physical therapy can help avoid the costs and risks of an invasive surgery.