Is Surgery Necessary for a Torn Meniscus? More Research

By /

Receive a Regenexx® Patient Info Packet by email and learn why it's a superior regenerative solution.

Is surgery necessary for a torn meniscus

Is surgery necessary for a torn meniscus? The answer, based on the research, is now clear. If you’re over age 35, the most common surgery used to treat a torn meniscus called partial meniscectomy is useless. Now new research out of Johns Hopkins quantifies the massive scale of the epidemic of ineffective knee meniscus surgeries . Let’s dig in.

What Is a Meniscus?

Is surgery necessary for a torn meniscus 2The meniscus in the knee is a piece of tissue that’s shaped like a figure 8. The two rounded ends of the thigh bone sit in each one of the circles of the figure 8. The meniscus is a spacer that keeps the bones apart and also supplies some stability for the joint.

The meniscus can tear. There are many different types and locations of tears, which may or may not have some significance as it relates to recovery. Research has shown that meniscus tears as we age are very common and should be treated with the same concern as wrinkles. (1)

Does a Torn Meniscus Cause Pain?

The first question anyone who has a meniscus tear on MRI asks themselves is, “Is surgery necessary for a torn meniscus? Before answering that question, we need to answer a simpler one. Is the torn meniscus causing your knee pain?

If you just got your MRI CD or link to the patient portal online, you may want to watch my video on how to read those images:

Regrettably, we as physicians, have educated several generations of patients to get alarmed when they see a meniscus tear on an MRI report. The idea was supposed to be that there was a strong correlation between a meniscus tear and pain. However, many research studies have debunked this idea. Patients with and without knee pain both have meniscus tears with about the same frequency (2).

In summary, in middle-aged patients, finding a meniscus tear on an MRI in a patient with knee pain should, for the most part, be ignored. This is because there is unlikely to be a connection between that tear and why your knee hurts. Hence, planning surgery on a structure that isn’t causing the pain in the first place may be a bad idea. However, we’ll explore that next.

Is Surgery Necessary for a Torn Meniscus?

The most common surgery for a torn meniscus is called an arthroscopic partial meniscectomy (APM). This means that the surgeon removes the torn part. Only a handful of meniscus surgeries are meniscal repairs, despite patients often believing that their surgery will “repair” their meniscus tear (3). Hence, if you have been told you need knee surgery to treat a meniscus tear, there’s a greater than 90% chance it’s an APM surgery.

There have been many high-quality research studies over the past decade or more that were designed to answer the specific question, “Is surgery necessary for a torn meniscus?”. What did they show? No matter what the clinical scenario: meniscus tear with arthritis, meniscus tear without arthritis, or locking of the knee, all three large studies showed that meniscus surgery was not effective or no better than just physical therapy (4,5,6).

New Research from Johns Hopkins

This new research first recognized that based on the published research we reviewed above showing that meniscectomy is ineffective, orthopedic surgeons should be phasing out the procedure (7). To learn more they reviewed hundreds of thousands of knee surgeries. What did they find? Two-thirds of all arthroscopic knee surgeries are still partial meniscectomies! The authors concluded:

“These data suggest a significant and troubling disparity between evidence and practice for one of the most common operations performed in the United States.”

Hence, we have a huge disparity between the research that tells us orthopedic surgeons should no longer be offering these procedures, and, actual practice where they are still commonly offered. Why? I suspect that if the average US hospital or university medical center were to get rid of 2/3rds of its knee surgery cases by phasing out meniscectomy, it wouldn’t be able to make payroll.

Can Menisectomy Be Harmful?

All surgeries have risks. Meniscectomy is no different and those risks include infection, blood clots, nerve damage, etc… However, most patients don’t know or are never told that there is research suggesting that meniscectomy may increase the likelihood for arthritis (8). In one study, the authors found that patients who had meniscectomy were 4.5 times as likely to develop arthritis versus those patients who didn’t have the surgery.

Is There a Better Way?

We’ve been treating patients with knee meniscus tears with precise ultrasound and x-ray guided injections of orthobiologics for many years, see my video below for more information:

In addition, I have written a whole book on ways to avoid knee surgery:

The upshot? Despite all of the research showing that meniscectomy should be a procedure that physicians retired years ago, it’s still the most common knee surgery in the United States. Hence, don’t let yourself be a knee surgery victim, do your homework!


References:

1. Risberg MA, Degenerative meniscus tears should be looked upon as wrinkles with age—and should be treated accordingly. 
2. Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008;359(11):1108–1115.
3. Montgomery, SR. Cross-sectional analysis of trends in meniscectomy and meniscus repair. Orthopedics. 2013;36(8):e1007-e1013
4. Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. N Engl J Med 2013; 369:2515-2524
5. Katz JN, Brophy RH, Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. N Engl J Med 2013; 368:1675-1684
6. Sihvonen R, Englund M, Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial. Ann Intern Med. [Epub ahead of print 9 February 2016]164:449–455. doi: 10.7326/M15-0899
7. Stahel PF, Wang P, Hutfless S, et al. Surgeon Practice Patterns of Arthroscopic Partial Meniscectomy for Degenerative Disease in the United StatesA Measure of Low-Value Care. JAMA Surg. 2018;153(5):494–496.
8. Roemer FW, Kwoh CK, Hannon MJ, et al. Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year. Eur Radiol. 2017;27(1):404–413.
Category: Knee

Leave a Reply

Your email address will not be published. Required fields are marked *

4 thoughts on “Is Surgery Necessary for a Torn Meniscus? More Research

  1. carter alexander

    Am 83 yo
    Have bilat menisectomies. FB repairs from late 50’s. Have run 5 marathons in my late 40’s and early 50’s. Numerous 10 and 15 K’s all without problems. Still no arthritis and I now farm for a living. Don’t necessarily agree with article. We are all different and one size does not fit all.

    1. Regenexx Team

      Hi Carter,
      We completely agree! Which is why we use our Flexible Lab Platform to customize what we do to the individual patient and issue. Please see: https://regenexx.com/blog/regenexx-flexible-lab-platform/ Glad to hear you’ve done so well!

  2. Beth

    Where were you years ago?Did a repair and then half of it ended up rolled in a circle. Then they took it all out

    1. Regenexx Team

      Hi Beth,
      We’ve been doing this for a very long time. Sorry we missed you!

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.
View Profile

Get Blog Updates by Email

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
Learn More
Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
Learn More
Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
Learn More
Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

Is Regenexx Right For You?

Request a free Regenexx Info Packet

REGENEXX WEBINARS

Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar

RECEIVE BLOG ARTICLES BY EMAIL

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog

FOLLOW US

Copyright © Regenexx 2019. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.

LinkedIn
Email