If you are one of the thousands of middle-aged people considering arthroscopic surgery to fix knee pain and movement problems from degenerative meniscus tears, you might want to hold off on going under the knife.
Research published in July 2016 in The British Medical Journal finds that exercise therapy may be as good as surgery at improving function and activity level.
Studies done previously on the effectiveness of arthroscopic surgery for this type of knee problem found that it worked no better than placebo surgery—at least for older folks. Researchers wanted to see if those findings held up for middle-aged patients as well.
How the study was done
Scientists divided 140 adults in Denmark and Norway, ranging in age from 35 to 59, who had degenerative medial meniscal tears into two groups: One group received arthroscopic partial meniscectomy followed by simple exercises to perform at home while the others had no surgery but 12 weeks of exercise therapy. The study differed from others in that instead of comparing arthroscopic surgery to sham surgery it compared it to exercise therapy.
The therapy was supervised and included such techniques as riding on a stationary bike, squats, and leg curls. Follow-up assessments were conducted at three, 12, and 24 months with muscle-strength testing at three and 12 months.
Results of the randomized controlled trial showed no clinically relevant difference between the two groups for improvement in pain and knee function after two years. The exercise therapy group, however, did show improvement in muscle strength after three months.
Why surgery may not help knee damage
“It is often puzzling to patients why surgery isn’t effective when there is meniscal damage,” says Roger Chou, M.D., professor in the division of general internal medicine and geriatrics at Oregon Health & Science University in Portland.
One explanation he offers is that meniscus tears are common and people frequently don’t feel symptoms. “So knee pain can’t necessarily be attributed to the tear—but the tendency is to want to ‘fix’ a tear if it’s seen,” he says. “It could also be that the surgery simply doesn’t work, even if the meniscus is causing symptoms.”
Chou adds that some research suggests that removing meniscus tissue can accelerate arthritis, “which could cause problems down the road.”
A safer alternative
In an accompanying editorial, Teppo L N Järvinen, a professor in the department of orthopaedics at the University of Helsinki in Finland, and Gordon Guyatt, a professor in the department of clinical epidemiology at McMaster University in Hamilton, Canada, wrote that a mounting body of research shows that surgery does not help patients any more than exercise therapy. But they added that the orthopedic community is reluctant to change its ways.
“Surgery is rarely a good treatment for musculoskeletal pain,” says study author Ewa M. Roos, a professor at the Institute of Sports Science and Clinical Biomechanics at the University of Southern Denmark. “Usually the better or safer way to go is with a less invasive first step.”
The bottom line
Before signing up for arthroscopic surgery on your knee for meniscal tears, ask your doctor what the evidence shows. To relieve knee pain and improve function, consider exercise therapy first.