Does Meniscus Repair Work? Another Study Shows the Surgery’s a Sham…

by Chris Centeno, MD /

does meniscus repair work

I saw a middle-aged patient yesterday who injured his knee two weeks ago. He had an immediate MRI that showed a meniscus tear and some arthritis. He’s an established patient, so when a prestigious orthopedic clinic told him he needed surgery, he knew enough to check back with me. He, like many other patients, was surprised to learn that this invasive procedure is no better than a sham surgery. So if we have these high-level studies answering the question, “Does meniscus repair work?” again and again, why are my patients still getting offered this surgery? Why is their insurance company still covering it?

The Research That Answers the Question, “Does Meniscus Repair Work?”

Believe it or not, meniscus surgery is one of the best-studied procedures on earth. We have at least five different high-quality, large randomized controlled trials that show it’s next to useless. The newest one that added a few more nails to the proverbial coffin was just published a few weeks back. It compared physical therapy (PT) alone to meniscus surgery alone to treat a degenerative meniscus tear (the ones that show up in middle-aged people on MRIs after the knee is injured or hurts). Only one in five patients in the exercise group had continued pain after three months of PT. More interesting was that when that 19% of patients who failed PT chose surgery, it provided no additional benefit. Ouch!

This study gets added to others that show that acute meniscus-tear surgery is no better than physical therapy, that debridement is no better than placebo surgery, that surgery for a locking meniscus is no better than no surgery, and others. You get the picture. Meniscus surgery has been studied from every possible angle, and every time we see a large, high-level study performed, it fails like a hastily constructed balsa-wood bridge trying to hold a Sherman tank.

Why Are My Patients Still Getting This Procedure?

There’s a very nice article in the NY Times this week on why patients still get offered surgeries like low-back fusion, disc surgery, and meniscus surgery when the high-level research shows these procedures don’t work. The bottom line is there only seems to be one thing that we know causes surgeons to stop offering these procedures—killing reimbursement. Given that it’s been established that meniscus surgery is a sham, how much longer could meniscus surgery survive before insurance-company medical directors begin pulling reimbursement?

That’s a complex question. One of the issues is that there is a literal army of financial stakeholders making money off operating on the meniscus who will all oppose the retirement of this sham procedure. Hospitals and surgery centers make money—after all, this is still the most common elective orthopedic procedure in the U.S. So if no meniscus surgeries were performed beginning in 2017, 400,000 fewer orthopedic surgeries would be performed, reducing hospital revenues by about a billion USDs. Obviously, surgical revenues for many orthopedic surgery practices would be decimated. Finally, there are no less than 100 companies that sell devices, implants, and instruments that support meniscus surgery, so the medical-device industry would take a huge hit.

So how much longer does meniscus surgery have? My guess is that we’ll see the first changes in reimbursement begin by next year. In addition, some European National Health Systems are considering eliminating coverage.

The upshot? The answer to the proverbial question, “Does meniscus repair work?”is a resounding No!  Meniscus surgery is a sham. It has failed to produce results either better than placebo or physical therapy now in many high-level studies. So as a memo to my orthopedic colleagues, please stop offering this useless procedure to my patients!

Category: Knee, Latest News

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25 thoughts on “Does Meniscus Repair Work? Another Study Shows the Surgery’s a Sham…

  1. Marie-Aimee Ginbey

    Ive had the surgery in australia too for a meniscus tear debridement.. Meaning clean out of arthritis… Now ive had living stemcells injections in germany to see how i go.. Both my knees have osteoporosis, its difficult to know what next…

    1. Regenexx Team Post author

      Marie-Aimee

      Go see Dr. Boundy in Kingswood, Australia! http://www.nssm.com.au/

  2. Debra

    I am in the medical proession. I tore my meniscus 10 years ago at age 47. Had a knee scope and the Surgeon decided to do a Meniscus repair with arrows. It was a disaster. I developed an inflammatory response to those arrows and could not walk. I developed adhesive capsulitis as well. I had to have a manipulation as well as two more knee scopes. 80% of my meniscus is gone. I’ve never walked right since. My life changed forever. It hurts every day. It’s a bad way to live. Don’t do it people!

    1. Regenexx Team Post author

      Thanks Debra! It’s in sharing your story that gives other people the chance to see how this plays out in real life

  3. Perry Langford, D.D.S.

    I realize that my personal experience with meniscal surgery is mearly anticdotal and not scientific evidence. Having said that, I can report very satisfying results as a patient who has had partial meniscectomies on three different occasions over the past 30+ years: left knee in 2011, right knee in 1984 and again in 2016. My right knee was injured in about 1984 while I was running. After putting up with pain and limping for about three months I had surgery. Following recovery and rehab this knee was 100% trouble free until I re-injured it (medial meniscus tear) in February, 2016, while running intervals like a 30 y/o (I’m 74 now). I was aware of previous studies reporting no differences in result between surgery vs. no surgery, so I tried conservative exercises like knee extensions with minimal weight, stretching, easy bicycle riding, and slow non-aggressive walking every day. Three months later there was no significant improvement in my pain level and dysfunction. I had a mountain climb activity scheduled for late July, so I opted for surgery in early June, 2016. Following arthroscopic surgery to remove the substantially ragged and torn portion of the meniscus I focused on rehab activities. My knee then gradually improved over the next 6 weeks, and I was able to complete the ascent and downclimb of a steep sided high peak in Nevada in late July. Of course, it is possible that with a few more months of therapy without surgical intervention I may have gotten better. But based upon my rapid recovery and return to function postoperatively compared to virtually no improvement during the months prior to surgery, I’m glad that the surgery was done. Even today, some two months post op, the improvement continues. Are there any good studies showing arthroscopic evidence, or MRI evidence, of a ripped meniscus repairing itself after any period of physical therapy? Is there similar documented evidence of stem cell treatment leading to meniscal repair? Since much of the meniscus is avascular, how would it undergo repair?

    1. Regenexx Team Post author

      Peggy,

      Given that studies show 81% of patients who have had even a small section of meniscus removed develop arthritis in the operated knee within the first year, it sounds like you are in the lucky 19%! Improvement from the surgery has a lot to do with what caused the tear, as a traumatic tear in a healthy knee has a greater chance of healing than a degenerative tear caused by a lack of functional stem cells in the joint. Physical therapy often helps, but not by healing the tear, by easing inflammation, strengthening muscles supporting the knee, and improving the knee’s range of motion. Much of the meniscus is avascular. Regenexx procedures have components which both bring the repair team to the area, and can establish new blood supply to a area without good blood supply. http://www.regenexx.com/meniscus-tears/

  4. Joe Abodeely

    How successful are hip (femur ball) procedures ?

    1. Regenexx Team Post author

      Joe,
      Not something we could recommend. Each case is different, but the issues the procedure generally addresses can usually be addressed percutaneously. Please see: http://www.regenexx.com/hip-osteonecrosis-stem-cell-treatment/ and http://www.regenexx.com/hip-labrum-surgery-complications/ and http://www.regenexx.com/blog/removing-hip-bone-spurs-hip-impingement-no-better-nothing/

  5. Gustavo A. Rodriguez

    I have the medial meniscus on both knees torn, I have never being operated, I take glucosamine/chondroitin, problema solved., right knee, tore 8/’96, the left, 4/’07, on both occassions the Dr. suggested surgery and the GC would not work.

    You’ll be back.

    1. Regenexx Team Post author

      Gustavo,
      Really glad you proved the old surgical paradigm wrong!

  6. Tony Julianelle

    Dr. Centeno,
    It would be bad enough if meniscus surgery simply didn’t work, but hasn’t the research showed that patients tend to fair worse if they have the surgery versus to doing nothing?

    I had a meniscus trim in December 2006. I was told quite point blank by the surgeon’s p.a. that I needed surgery. and that “you are going to be fine”. I asked the surgeon about alternatives to surgery and I remember his words to this day, “I suppose you could try physical therapy if you really wanted to, but you would be back here in a few months”.

    I had two rounds of stem cells with you and Dr. Schultz. This has really helped but obviously with a trimmed meniscus, it can only do so much.

    I teach math at U. of Vermont and it burns me when I talk with students who are having meniscus surgery sometimes by the same surgeon who screwed up my knee. Bad enough to lower the quality of my life at 56 years, but these kids are only about 20 years old.

    Bests,
    Tony Julianelle

    1. Regenexx Team Post author

      Tony,
      We agree! Removing necessary parts of anyone’s body for no benefit is a travesty, but removing necessary parts of anyone’s body causing damage rather than benefit, is worse. Doing that to a young person who has no idea of the long term consequences is worse still.

  7. Jim Marks

    Hi – I had 3 meniscus surgeries – 1 on 1 knee and 2 on the other. I was pretty athletic, and when I would plant my foot, I’d feel something move in my knee. It would swell up and I’d wait for swelling to go down and the cycle would repeat. It wasn’t until I had my surgeries that the problem was fixed. So it did work for me. Unfortunately, I am now 64 with no cartilage left on outside of knee, and very little left on inside – bone on bone.

    1. Regenexx Team Post author

      Jim,
      Unfortunately a predictable outcome. Figuring out and treating what causes the problem, rather than cutting out the symptom of the problem is a much better solution. Removing sections of the meniscus both causes instability and leaves the cartilage unprotected. This is one of several very treatable scenarios that can cause that type of thing: http://www.regenexx.com/knee-locking-up/

  8. John R. Hutchinson

    So, what is the alternative

    1. Regenexx Team Post author

      John,

      Yes, please see: http://www.regenexx.com/meniscus-tears/

  9. jag kudale

    If surgery does not work, does stem cell or platelet injections work? any research on that?

  10. Masuma

    Is it true that meniscus-arthroscopic surgery is effective in cases where there is no osteoporosis present, and when there is both OA and meniscus issues the problem is worsened (as in my case)! Numerous letters to the NYTimes article argued that for them the surgery was effective!

    1. Regenexx Team Post author

      Masuma,

      The is an important piece of data missing which only time can inform, as studies show not that it works in cases where there is no arthritis, but that 81% of patients who had meniscus surgery developed arthritis in the operated knee within a year.. http://www.regenexx.com/blog/meniscus-surgery-arthritis/ and http://www.regenexx.com/blog/meniscus-surgery-alternatives/

  11. james reardon

    I’m 45 years old and just had the Regenexx procedure done to my right knee and aside from the many injections I am glad I chose not to do the surgery after reading the reports of the surgery not turning out well for you the long term. To be cut open only to have to do another surgery in the near future seemed like a bad option to me

    1. Regenexx Team Post author

      James,

      Good decision, as in the words of Crossfit Pro Matt Chan, “It’s important to keep all your body parts!”, and studies prove him correct.

  12. BL

    Here’s the nightmare that’s happened to me:

    Following simple routine partial meniscectomy, I could never again walk without pain that I’d never had prior to the surgery. 2 years later was finally diagnosed an articular cartilage defect with bone edema that was not present at or before the time of surgery. There were no warnings from the surgeon that the surgery oftentimes leads to cartilage defects. His position was that I was just healing “slowly”.

    Fast forward a few years later, you will never believe what happened to me. I went in for another type of knee surgery, with another doctor, the exact nature of which I prefer not to disclose. Part of the surgery involved an arthroscopic portion. Being completely aware that this is the surgical “danger” zone, I was extremely direct and told him that if he were to find a meniscus tear during the arthroscopic portion, to please just photograph it and leave it alone. I would plan on a BMAC. A couple days before surgery, I called his Medical assistant to again reiterate my directions that there would be no unauthorized procedures. She reassured me that the doctor would not perform any thing other than what was discussed prior to surgery. Well , low and behold, I woke up with another partial meniscus trim! The surgeon said, at the time of the post-surgery check up appt, that it was “so small”, that I would be fine, not to worry or drive myself crazy about it. Needless to say, I am not doing well at all. And I have more cartilage damage on MRI now compared to pre-surgery!!!!! I can not get my head around the reason they continue to offer this surgery as a viable option. Even in my case where I have a devastatingly poor outcome on the first meniscus trim, why would a surgeon opt to do this again to the patient, against his/her wishes?

    I am sharing this information as a warning to others. I hope patients take note.

    1. Regenexx Team Post author

      BL,
      Thanks for sharing your story. Sadly it’s not unusual. We hope patients and doctors take note! http://www.regenexx.com/blog/the-end-meniscus-surgery/

  13. BL

    I wanted to offer an answer on why insurance pays for meniscus surgery. I think that they are aware that there is a huge chance that once a patient gets this, they have “knee pain patients” for life, always at the orthopedic looking for diagnoses & solutions and yet those “specialists” have none. And all of it generates significant medical costs. It just keeps the money flowing between surgeon, physical therapists, insurance and medical device companies. Those entities are happy….the ones losing out would be the patient himself and a patient employer, assuming they are subsidizing the medical benefit premiums.

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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