Meniscus Tear? Consider Therapy Over Surgery

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If you have hit middle age you’ve likely suffered a meniscal tear at some point in recent years, it’s likely that surgical repair was, or will be, the recommended treatment.  But a new study published in The British Medical Journal suggests that you might want to nix surgery and consider exercise therapy, instead.

The meniscus is a piece of cartilage that sits in your knee and provides a cushion between your femur bone and your tibia bone. There are actually two menisci in each knee joint and they are often at risk of trauma associated with physical activities and sports that require strong pivots, starts and stops (basketball, tennis, etc.). In fact, the meniscus can be damaged or torn during any activity (or accident) that 1) puts excessive pressure on the knee joint or 2) involves rotating or twisting the joint.  You can even tear it when standing up suddenly.  Meniscal tears are pretty common among kids, teens, and adults.

Individuals with osteoarthritis are at higher risk of a meniscus tear because of the degradation of the knee joint. By the time you hit middle age, excess weight and cumulative wear and tear on the knee joints heightens the risk. When a meniscal tear occurs you may hear a popping sound and you will likely experience pain, swelling, sudden limited range-of-motion, a feeling of the knee locking up, or the feeling that your knee is suddenly unstable.  An MRI helps to diagnose the tear in most cases, but it is not 100 percent reliable.  An MRI diagnosis can help most patients avoid more invasive diagnostic arthroscopy.

You can try a more conservative approach to recovery including rest, using crutches to avoid weight-bearing, icing the injured knee, using compression to reduce inflammation, elevating the knee whenever possible and, at some point, physical rehabilitation.  (The well-known acronym, RICE, stands for** rest, ice, compression and e** levation.)

It can take one to three months for the torn meniscus to heal and in many cases, depending on the type and location of the tear, doctors will recommend surgery to repair the tear.  But is knee surgery truly the best option, especially for the large group of middle-aged individuals at significant risk for a meniscal tear due to aging?

According to the June 2016 study in The British Medical Journal, supervised exercise therapy is as effective as surgery for middle-aged patients who sustain a meniscal tear.  In the randomized control study 140 adults (average age, 50) with degenerative meniscal tears seen on MRI were selected for the study.  Ninety-six percent of the subjects had no radiographic signs of osteoarthritis.  Half the group participated in a 12-week supervised exercise program which included two to three sessions weekly plus daily home exercises.  The other half had arthroscopic knee surgery followed by daily home exercise instruction.

Thigh muscle strength was assessed at the three-month mark and knee function was reported by the patients at the two-year mark.  No clinical differences were noted in the two groups with regards to pain, function in sport and recreation activities, and knee-related quality of life. Thigh strength had improved in both groups at the three-month post-treatment assessment.  It should be noted that 13 percent of the exercise group crossed over to surgery during the follow-up period with no appreciable additional improvements.  Nether group had serious adverse outcomes.

The researchers suggest that the results should inspire clinicians to strongly consider recommending the option of supervised exercise to patients in this age group who have similar MRI and x-ray findings.  In fact, they also suggest that surgery has become too widespread a treatment for this particular condition, despite earlier research and evidence showing that exercise was a viable alternative.  Given the option of having surgery or committing to a three-month exercise program to repair your knee, which would you prefer?  At least you now know there are choices.

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Amy Hendel, also known as The HealthGal, is a Physician Assistant, nutritionist and fitness expert. As a health media personality, she's been reporting and blogging on lifestyle issues and health news for over 20 years. Author of The 4 Habits of Healthy Families, her website offers daily health reports, links to her blogs, and a library of lifestyle video segments.

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