Suffering from a Meniscus Tear? Why Arthroscopic Knee Surgery Isn’t the Answer

by Chris Centeno, MD /

Alternatives to arthroscopic meniscus surgery

For several decades in orthopedic care, the traditional solution to meniscus tears has been to identify them on an MRI and cut out the offending piece. While there’s little doubt that meniscus degeneration is at play in the cascade of knee arthritis, how all of this works is not so well understood. Now, a new study continues to point in the direction that meniscus surgery is likely the exact opposite of what we should be doing to help middle-aged patients with knee pain.

What is the Meniscus?

meniscus tear - arthroscopic removalThe meniscus is a spacer that helps to cushion the knee cartilage. This structure can get normal tears as we age, much like your face naturally wrinkles over time. While a huge industry has emerged around removing parts of the meniscus when tears are seen on an MRI, there’s little hard scientific evidence that this is a good idea.

Alternatives to Arthroscopic Knee Surgery for a Meniscus Tear

To understand why the science now supports that our whole surgical approach to treating meniscus tears is ill-advised, let’s follow a 45- year-old patient who develops knee pain when hiking or running. The patient moves suddenly to avoid a rock, hears a pop in his knee, and his knee begins to swell. All of a sudden, an otherwise active middle-aged guy can’t hike or run without pain. At first the patient tries to ignore it, but after a week of no improvement, he visits the family doctor. An MRI shows some swelling and a meniscus tear and our guy is referred to an orthopedic surgeon.

Let’s stop our story right here for a moment. While the patient and his physicians are convinced they have found the source of his knee pain, the hardcore research of the last few years tells a different story. In fact, it’s highly likely that, had we performed the MRI months before the knee was injured, we would’ve seen the same tear! Additionally, if we performed an MRI on our patient’s 10 best buddies, all of whom have no knee pain, about half would show a meniscus tear that looked just like our patient’s. So regrettably, the meniscus tear is a “red herring”, not a diagnosis.

Surgical Meniscus “Repair” is Usually Code for Meniscus Removal

Our patient sees the orthopedic surgeon for a quick and cursory 5-minute visit. The patient is then scheduled for surgery. The patient believes he’s getting his knee meniscus “repaired” when really all the surgeon is doing is cutting out the torn part. The patient keeps off his knee for a few weeks, wears a special brace, and then feels better for a year or two . Until his knee swells again–and a new MRI shows not only another tear, but some cartilage damage as well. He’s told by the surgeon that he needs another surgery to remove more meniscus and cartilage pieces and to expect a knee replacement at some point in the not-too-distant future.

Let’s stop our story again here and recall that the surgery to “repair” the meniscus has been shown in multiple studies to be no better than a fake or placebo surgery . Hence, we have no scientific evidence that this procedure will help this patient’s knee. In fact, other studies show that in all likelihood, removing some of the knee meniscus will only cause more knee arthritis.

While the likeliness of knee arthritis after a meniscus surgery seems to be due to less cushioning in the joint for protecting the cartilage, another reason may be that removing  the damaged cells is the last thing the degenerating meniscus needs.

Your Meniscus is Alive!

It’s easy to conceptualize the knee meniscus as just an inanimate object, like a gasket or rubber piece in the mechanical engine that is your knee. However, it’s actually living tissue that’s made up of cells. A recent study makes a fine point of this by using sophisticated immunostaining to observe the number of living cells in the meniscus. The researchers found that there were fewer functional cells in the degenerated meniscus tissue that show tears on an MRI. This finding is important for the patient mentioned in the sequence of events described above and anyone else suffering from knee pain due to meniscus tears.

For example, if degenerating meniscus tissue leads to tears—which usually have nothing to do with why the knee began hurting—then removing the torn piece decreases the total number of meniscus cells left in the knee, logically leading to the progression of arthritis. So shouldn’t we be adding cells instead of removing them?

Let’s take the wrinkle analogy discussed above. If meniscus tears are about as clinically meaningful as face wrinkles, what if our solution to the latter problem was to surgically remove each wrinkle? It wouldn’t be long before the face was a mess! In this analogy we can clearly see that it would be far better to inject something to plump up the skin and get rid of the wrinkle for a time, which is what’s done with collagen shots in cosmetic clinics. This is also done in orthopedic clinics when hyaluronic acid gel shots are injected for knee arthritis. In addition, like our meniscus tissue, the research shows that the wrinkles are caused by a decrease in the number of living cells, which leads to fewer extra-cellular matrices being produced. Hence, injecting cells into the wrinkle would also do the trick!

The upshot? Removing parts of a meniscus is not a smart idea, despite the fact that a multi-billion dollar medical industry has thrived on the outdated concept. This is not only because the meniscus is an important cushion protecting the knee, but also because we should be adding cells to the knee, not removing them! So how can we add cells to a knee meniscus? We do this every day around the Regenexx Network with one of our patented Regenexx procedures, which uses precise ultrasound guidance to inject the knee meniscus with the patient’s own stem cells. Because we believe in facing the problem head on instead of ignoring the consequences that will pop up later on down the road.

Challenge the old doctrine of cell removal as a solution and consider reinvigorating your knee with stem cells instead. Your decision could mean the difference between a temporary fix and chronic pain—or healthy knees that will last you a lifetime.

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41 thoughts on “Suffering from a Meniscus Tear? Why Arthroscopic Knee Surgery Isn’t the Answer

  1. SH

    Is there any help for a bucket handle lateral meniscus tear that has lodged in the knee joint?

    1. Regenexx Team Post author

      SH,
      Yes, we have treated them successfully, despite the fact that this type of meniscus tear is the one that generally does require surgery. This is similar case: https://regenexx.com/blog/can-you-treat-a-meniscus-tear-without-surgery/

      1. Kevin Jepson

        Hello I’ve had that injury and surgery. As they trimmed quite a bit off the meniscus, I’m worried about the future of my knee. I am 55 years old, very fit and active and wondered if your treatment would be a benefit for me? Thanks Kevin

        1. Regenexx Team Post author

          Kevin,
          Adding cells to the meniscus which now has less even less cells than caused it to tear in the first place, would likely be a good idea.

  2. Josie mock

    Email me at [email protected] yahoo.com. I sent you all an email about an ankle enjury, please reply. Thanks! Josie mock or have Joel call me. He knows me. 619 6160226

    1. Regenexx Team Post author

      Josie,
      Sent you an email.

  3. Rich DeLucia

    I’m in my fifth month of Regenexx knee stem cell procedure, after my mri and consultation showing a meniscus tear and some arthritis. I felt better after day one, after 5 weeks removing my brace I was walking stairs and walking around without soreness as waste case prior. I’ve recently started strengthening my leg more aggressively, 35 to 65 minutes a day on elliptical or stairs temperature or treadmill, only some soreness after52 minutes, that goes away overnight, I’ve just started, leg extensions, 2 and 1 legged squats, no problems, hope this helps??

    1. Regenexx Team Post author

      Rich,
      Wonderful news and progress! Thanks for sharing it as real patient feedback is so helpful to others!

  4. Zai Floyd

    Regenexx Team,

    I am so happy I found your website! I was dreaded for the infamous mid-life meniscus tear surgery before finding out that I have no tear (surprise.) Instead I am faced with loss of cartilage. My doctor has proposed steroid shots followed by H A shots. I have been reading and was already hesitant of the cortisteroids. I have lots of pain but I would rather hang on and wait to get the H A shots than do something to damage my cells. Could Regenexx help me? Will trying the HA shots first help?

    How can I prevent any more cartilage loss. I compete in ballrooom dancing but admitedly I am overweight. I have recently lost 35 lbs and trying to lose more. Of course this hiccup has slowed down my process.

    1. Regenexx Team Post author

      Zai,
      SO GLAD you knew not to get the steroid shots as they can do incredible damage! Best case scenario would be to intervene now with your platelets or stem cells, depending on which is needed. If that is not possible, the HA shots have no regenerative or repair potential, but are a lubricant which often helps with pain temporarily. They might buy you more time and will not interfere with future regenerative treatment. https://regenexx.com/blog/all-i-want-to-do-is-dance/

  5. DONNA MCNULTY

    CAN YOU HELP EVEN AFTER i’VE HAD MULTIPLE MENISCUS TEARS AND SURGERIES (3). MY DOCTOR TELLS ME I AM BONE ON BONE ON THE LATERAL SIDE, AND HAVE SIGNIFICANT DAMAGE UNDER MY KNEECAP. I STILL HAVE PAIN IN MY KNEE AND MY KNEE SLIPS OUT OF PLACE ALMOST EVERYDAY NOW, BUT THE DOCTOR SAYS i HAVE NO LIGAMENT DAMAGE AND HAS PRESCRIBED MORE THERAPY. i HAVE BEEN DOING MY EXCERCIZES EVERYDAY AND EVEN GO TO THE GYM AND DO AS MUCH AS I CAN TO GET AS STRONG AS I CAN BECAUSE THE LAST TIME I SAW HIM HE SAID I WAS GOING TO HAVE TO HAVE A REPLACEMENT AND THAT EVERYTHING THAT WE WERE DOING WAS JUST A BAND-AID. i JUST WANT TO BE ABLE TO WALK AND SWIM AGAIN WITHOUT PAIN.. DO YOU HAVE ANY DOCTORS IN THE CHICAGO AREA?

    1. Regenexx Team Post author

      Donna,
      Many of our patients have had multiple meniscus surgeries. But with your knee slipping out of place daily it would be important to be examined by someone who is trained to determine what is going on before more damage is done, or, if you would like to speak to one of our physicians first to see what they feel can realistically be done, fill out the Regenexx Candidate Form on this page:http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/ Yes, we have two Chicago locations and several in the general area. Here is link: http://www.regenexx.com/find-a-physician/

  6. Bart Nelson

    Had meniscus surgery a week ago. I asked my Doc about your procedures. His bottom line was that if your procedures were effective Insurance companies would be paying for your procedure before paying the much higher cost of total knee surgery. Your response please.

    1. Regenexx Team Post author

      Bart,
      If only that were true! There are thousands of people walking around out there for whom they worked, many of whom became our patients because of the damage done by surgery. That said, it’s entirely different paradigm. In 15-20 years, orthopedic surgery will be the rarity, and most orthopedic problems will be treated through a needle. https://youtu.be/TFSzof3tlMc

  7. James Reardon

    Thought of having the meniscus surgery and saw the doc about this but did not ask him about the Regenexx procedures thinking he would give me the same answer as you got from you’re doctor . A response to this please as well .

    1. Regenexx Team Post author

      James,
      Orthopedic Surgeons want the best for their patients as much as we do. The issue is simply that orthopedic surgery and regenerative medicine are two completely different paradigms. We have an orthopedic surgeon in the Regenexx Provider Network. He calls himself a “Recovered” Orthopedic Surgeon because it occurred to him after having spent decades doing arthroscopies and joint replacements that there had to exist a better way. He did a comparative study on the outcomes of his knee replacement patients and his Regenexx knee patients. Considering one group had their knee joints amputated and a prosthesis inserted and one had injections of their own stem cells, the results were impressive. Studies show overwhelmingly that meniscus surgery is a net negative rather than a net positive: http://www.regenexx.com/bmj-chimes-scandalously-poor-evidence-for-orthopedic-surgery/ http://www.regenexx.com/?s=meniscus+surgery

  8. Lin

    Had Regenexx to feet and ankles 3 months ago. The pain continues, yet I am hopeful this works for me. HOw soon after RT can one resume Celebrex/anti-inflammatories?

    1. Regenexx Team Post author

      Lin,
      Feet and ankles take longer to respond than knees, as they are more complicated joints. It would be a better plan to take the Stem Cell Support Formula, as it has powerful anti-inflammatories, ingredients to help with pain and importantly ingredients which support the stem cells doing their job, where as NSAIDS like Celebrex interfere with that. http://www.regenexx.com/regenexx-advanced-stem-cell-support-formula/ However, it appears to be on backorder. You would probably be able to get it quicker here: http://www.amazon.com/s/ref=a9_sc_1?rh=i%3Aaps%2Ck%3Aregenexx+advanced+stem+cell+support+formula&keywords=regenexx+advanced+stem+cell+support+formula&ie=UTF8&qid=1453487500
      In the meantime, you might try some good quality fish oil, if you are not already doing that. Quality matters greatly with Fish Oil, so we’ve made our own which is on the same page as the Supplement, but to buy locally, here is a list of Brands to avoid. Anything NOT on the list from a good health food store would be good: http://www.regenexx.com/are-you-getting-ripped-off-by-your-fish-oil-brand/ .

      1. Ken M.

        Curamin is a supplement that can be taken to reduce inflamation and take away pain without side effects! It has done great for me and my knee damage! I just came out of the orthopedic surgeons office and have been recommended surgeory to repair the torn meniscus! I will be avoiding the surgeory! I am a martial artist and prefer something that is less invasive for this 52 year old with arthritis! I already have bone on bone and will probably require replacements eventually.

        1. Regenexx Team Post author

          Ken M.
          We definitely recommend Curcumin. Because quality control is such an issue with supplements, we’ve developed our own Curcumin/Turmeric Complex. It’s also one of the main ingredients in the Regenexx Advanced Stem Cell Support Formula. Curcumin needs bioperrine to be absorbed properly. Please see: https://regenexx.com/blog/curcumin-for-knee-arthritis/ and https://regenexx.com/blog/turmeric-compound-found-to-regenerate-neurons/ https://regenexx.com/blog/does-curcumin-work/ and https://regenexx.com/regenexx-advanced-stem-cell-support-formula/

  9. Mahmoud

    I’m indecisive about doing the meniscus tear surgery for my knee or try your product first. May I ask how long it takes to recover from meniscus tear, and will the torn part fix itself or how this will work?

    1. Mahmoud

      I forgot to mention that I am 33 years old and it’s bothers me in certain positions, I don’t see any swelling, or feel any stiffness yet, just pain after long kneeling and irritation sometimes

    2. Regenexx Team Post author

      Mahmoud,
      Meniscus surgery is one of those things that is a very clear net negative: http://www.regenexx.com/should-i-have-meniscus-surgery/ Here is how we treat the actual problem non-surgically without creating greater long term problems using your own platelets and stem cells: .http://www.regenexx.com/meniscus-tears/ https://youtu.be/B99ebcTbRKc Some case studies: https://regenexx.com/blog/can-you-treat-a-meniscus-tear-without-surgery/ http://www.regenexx.com/blog/meniscus-tear-repair/ An accurate diagnosis is key as there are many issues that can cause the symptoms you describe apart from, or along with, a Meniscus tear. Was this tear from a specific traumatic injury?

  10. Robyn

    I had a badly torn meniscus ‘tidied up’ ( surgeons words…he admitted it was just cleaning up the edges that were getting trapped and then becoming inflamed. I was walking on a crutch, could not drive and could not sleep. This was five years ago and I have had no trouble at all since. I have many acquaintances and friends who have had various kinds of knee surgery and all are very happy.
    Not saying your methods do not work but it is outrageous to say the surgery does not work.

    1. Regenexx Team Post author

      Robyn,
      Very happy meniscectomy worked for you, your friends and acquaintances! Recent studies demonstrate very different results,however, as do our patients as a good percentage of our knee patients come seeking help for the arthritis, cartilage damage and instability resulting from meniscus surgery. http://www.regenexx.com/should-i-have-meniscus-surgery/

  11. Swati Verma

    I am based out of Delhi, India and my problem is just the same as you described in your example. I request if you could let me know where would this stem cell treatment be available in Delhi.

    1. Regenexx Team Post author

      Swati,
      We have one of the Regenexx Physicians traveling to India several times a year to do Regenexx procedures. Here is the website: http://regenorthosport.in/

  12. Peter Lucas

    Hi Chris,

    Thanks for your article, it gives me some hope. I am a 50 year old male with a torn Meniscus in the right knee. I have had an MRI to confirm the problem. I have a been a runner since the age of 12 and will regularly do 8 to 10 km’s per day. I find running my mental get away where I can think. I would like to resume running again but have been told, like others I am sure, that persistence will lead to arthritis long-term.

    Do you have an associate in Australia that has adopted your philosophy and can assist with your treatment down under. I am getting desperate and would welcome any advice or referral. It has now been 2 years since the tear and the rest is killing me, I need to run again.

    1. Regenexx Team Post author

      Peter,
      Running is good for the body and the mind! Yes, we have a Regenexx Provider in Australia, Dr. Kevin Boundy of NSSM in Kingswood. Here is their website: http://www.nssm.com.au/

  13. Simo

    I had an arthroscopic knee surgery and trimmed the meniscus in 2003. It took me about a year to recover 2004…I suffered from nothing until March 2017 was in the gym and next day my knees were swollen and after an MRI Doc said I need a surgery..no explanation nothing…I don’t feel any pains just swollen knee..I don’t wish to go through an other surgery again…I hope this Regenexx is the future.

    1. Regenexx Team Post author

      Simo,
      We’d need to read the MRI. If you’d like us to take a look please submit the Candidate form so you can upload it along with your medical history. Please see: http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/

  14. Joelle Williams

    I just had a miniscus trimmed a day ago, sorry I didn’t see this site first. The doctor says I also have arthritis in that knee (is that why the knee crackles loudly when bending?) but hopes the miniscus trim would alleviate pain. 25years ago I had ACL reconstructive surgery on that same knee and have been very active since. My question is, what should I do now? I started a regimine of collogen hydrolosate 2 weeks ago in hopes of rebuilding cartilage. Should I pursue your treatment or wait to see how this recovery goes? Thankyou

    1. Regenexx Team Post author

      Joelle,
      The best time would be about 3-7 days after surgery. Here is the Interactive list of Regenexx Physicians: https://regenexx.com/find-a-physician/

  15. Cole Chapleski

    Is there any type of meniscus tear that you can not treat? I just had an MRI read by the doc today and he said that part of the meniscus is flipped up into the joint, between the MCL and the bone and I need surgery. Said he would do his best but would most likely have to take part of the meniscus out, which is exactly the fate I am trying to avoid.

  16. alma shandra victor

    I havent seen an orthopedic yet.I just got my mri results. Says I have 3 meniscus medial tear and a partially ruptured bakers cyst..? Should I consider your treatment?

    1. Regenexx Team Post author

      alma,
      The things you’ve mentioned are things we treat regularly. If you’d like to see if your particular situation would be a Candidate for treatment, please submit the “Am I a Candidate” form here: http://www.regenexx.com

  17. Michelle

    Hi my son is only 14 Years he has had a meniscus repair done last September but now is Experiencing swelling again! He’s specialist stated he may need another surgery to clean out the meniscus parts as the repair hasn’t worked! I’ve been reading up about your stem cell Procedure we live in New Zealand is there anyone practising this here? He is very sports minded and has played rep in Hockey and Softball! because he’s so young need Alternative options!

    1. Regenexx Team Post author

      Michelle,
      Really sorry to hear about what’s going on with your son’s knee. An important read: https://regenexx.com/blog/teen-knee-surgery/. We don’t have a Regenexx provider in New Zealand yet, but we do have one in Australia, Dr. Boundy at Nepean Specialist Sports Medicine. Please see: http://www.nssm.com.au

  18. Kevin Barnes

    5 years post op partial removal medial side now exhibiting symptoms of cartilage damages . I need to be active in job functions so this is a matter of survival. Good things with stem cell therapy but it there a chance any lost meniscus tissue could be regenerated along with the cartilage? NY recommendation please , Huntington Long Island.

    1. Regenexx Team Post author

      Kevin,
      The focus would be to restore function as in these cases: Please see: https://regenexx.com/blog/knee-arthritis-stem-cell-treatment/ https://regenexx.com/blog/ironman-stem-cell-procedure/ and https://regenexx.com/blog/knee-arthritis-stem-cell-treatment/ and https://regenexx.com/blog/climbing-inca-trail-knee-arthritis-regenexx/ Dr. Kramberg, is our NY Regenexx Provider. : https://www.rehabmd.com/?utm_source=regenexxreferral&utm_medium=webreferral&utm_campaign=regenexxlocations. For assistance in seeing if you would be a Candidate, and setting up an appointment, please call 855 622 7838

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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