You gotta love medicine. In no other profession would something that has been shown to be ineffective continue to be done. As an example, we’ve known for years now that knee meniscus surgery doesn’t work. Despite that, it’s still the most common knee procedure in the United States. We also have some research to show that it likely causes or at least facilitates the development of knee arthritis. In fact, my practice is full of patients who are on their second meniscectomy and have been told they now need a knee replacement. This morning I’d like to review some research that places another nail in the proverbial coffin of knee meniscus surgery. First, let’s review knee meniscus surgery.
Knee Meniscus Surgery
The meniscus is a cushion of tissue that protects the cartilage in the knee joint. It rests between the upper and lower leg bones where they meet to form the knee joint. The meniscus can become torn due to wear and tear, most commonly, or trauma due to an injury. Surgeons love to operate on the meniscus and do so to the tune of about 700,000 surgeries a year.
We have some research already that shows that meniscectomy isn’t good for your knee cartilage. For example, check out this study that demonstrated that meniscus surgery likely increases the onset of arthritis. Why would this happen?
A meniscectomy, which accounts for over 95% of meniscus surgeries, involves excising, or removing, pieces of the meniscus. A surgeon will access the knee joint (via an open incision or an arthroscope) and cut out the torn piece of meniscus. Knowing the meniscus is there to protect the cartilage, it’s easy to understand why slicing out pieces of it could leave the cartilage vulnerable and potentially lead to arthritis.
It’s important to understand that just because your MRI shows a meniscus tear, this doesn’t mean you need surgery, especially in middle-aged or elderly patients. Watch my video below to get a more in-depth understanding of this:
Now, let’s look at the new study to learn more.
Knee Meniscus Surgery Now Means Knee Arthritis Later
The purpose of the new study was to investigate how meniscectomy affected the knee structure long term. The study consisted of 57 patients, each having received an arthroscopic partial meniscectomy (for traumatic or degenerative meniscus tears) within a period of 5 to 12 years (8 years average) prior. Using radiology images both before and in the years following meniscectomy, researchers studied the meniscectomy knee and compared it to the opposite knee that did not undergo surgery.
The results? Nearly 63% of knee meniscus surgery patients developed knee arthritis in the meniscectomy knee within 8 years, on average, following surgery. Compare this to the opposite knee that was not operated on: 28% developed arthritis in that same time period.
A few other interesting findings included knee arthritis in the medial compartment of the knee in males that was just under 9% prior to surgery and climbed to nearly 59% during the study period (females went from 26% to 73%). For obese patients, 18% had medial knee arthritis prior to meniscus surgery while a whopping 100% had it in the years following. Finally, in patients who had degenerative meniscus tears (tears due to wear and tear), 10% had medial knee arthritis prior to surgery while just under 67% had knee arthritis after. In patients with traumatic meniscus tears (injury related), 21% had medial knee arthritis prior to surgery while 63% had knee arthritis after.
More You Need to Know About Knee Meniscus Surgery
Despite the fact that orthopedic surgeons keep performing meniscus surgery and insurance keeps covering it, there are an abundance of problems plaguing the procedure, and it’s likely we’ll see this surgery relegated to the medical history books in the not-too-distant future. Let’s take a look at just a few of the issues I’ve covered over the last decade or so:
- Just because you have a meniscus tear on your MRI, especially in middle-aged and older patients, this doesn’t mean the tear is causing the pain. Many middle-aged people have meniscus tears but no knee pain, so the two are not exclusive.
- Knee meniscus surgery patients are three times more likely to need a knee replacement.
- Knee meniscus surgery is no better than physical therapy for addressing knee pain and function.
- In one study a placebo fake knee surgery was found to be just as effective as knee meniscus surgery.
- Knee meniscus surgery was also found to provide no benefit for knee pain and knee locking.
The upshot? Avoid meniscus surgery! If a surgeon tells you that you need this procedure because you’re middle-aged and you did something to cause your knee to hurt and an MRI randomly shows a meniscus tear (that was likely there before the accident), please run away. It’s time for surgeons to retire this procedure!
What pep therapy be useful for the treatment of meniscus tears?
Isabel,
Pep therapy is a respiratory therapy. In the event that it was a typo for PRP, here is how we treat meniscus tears nonsurgically with platelet procedures like prp, and bone marrow stem cells, both from the patient. Please see: https://regenexx.com/meniscus-tears/
John T. Fairbank published his findings in 1948. So, for 70 years we should have known that hacking at the meniscus is a bad idea. Seventy years is a long time not to learn… Still, if the surgeon’s won’t learn, perhaps the patients might?
Brian,
That’s the hope, which is why we write so much about it…
Been reading your blog going on a couple years.
I had this done due to chronic knee pain about 3 years back.
As a non medical person, what you say sounds reasonable.
Considering your procedures are not covered by insurance and they are rather costly (probably worth it but one is limited by ones wallet), what can be done given the pain involved to avoid this procedure (meniscectomy).
john,
The most important thing is accurate diagnosis. A traumatic sports injury or large tear may cause pain, but most meniscus tears do not cause pain, so determining what is actually causing the pain is crucial. The exam is generally covered if your insurance is in network, so finding out what’s going on by examining you would be needed to advise. Generally speaking, avoiding steroid shots and NSAIDs, and taking Curcumin, good quality fish oil, and Chondroitin and Glucosamine can be helpful -or- the Regenexx Advanced Stem Cell Support Formula. Please see: https://regenexx.com/blog/curcumin-for-knee-arthritis/ and https://regenexx.com/blog/new-research-fish-oil-can-turn-bad-inflammation-into-healing/ and https://regenexx.com/blog/controlling-middle-old-aged-inflammation-critically-important/ and https://regenexx.com/blog/steroid-shots-for-knee-arthritis/ and https://regenexx.com/blog/steroid-shots-for-knee-arthritis/ and https://regenexx.com/regenexx-advanced-stem-cell-support-formula/
What can be done for those of us who had their menisci removed?
Can this be regrown?
How about implants?
Mike,
In the case of a complete meniscectomy, the meniscus can’t be regrown. While there are many types of implants being tried, we’ve not seen one that has been successful. We can usually still help with both pain and function. If you would like to see if you would be a Candidate and see what would be involved in your case, please submit the “Are You a Candidate” form, or let us know. Please see: https://regenexx.com/blog/hip-labrum-surgery-complications/
I’m now 76, physically healthy and active, former jogger, current aggressive bicyclist, mountain climber, and long distance backpacker. Over the years I have suffered traumatic tears of the medial menisci of both knees, once for the left knee, and twice for the right. The discomfort subsequent to these events prevented me from enjoying my customary activities. After several months of rest and attempts to rehab after each of these injuries I submitted to menisectomy surgeries. I’m happy to report that in my case the procedures worked. I continue to be pain free and able to engage in my usual active lifestyle. I believe that knee health depends upon staying active, as in “use it or lose it”.
Perry,
Your theory is correct! Physical activity is incredibly important. That said, if and when symptoms develop, be proactive and act quickly. Often just PRP can get things going back in the right direction.
I wish I read this article earlier. I had meniscus surgery on both knees in December 2018. I have never had pain relief. Prior to November 2018 I had no signs of arthritic pain. Yesterday, I was told I need a knee replacement in both knees. 50 years old, disappointed and mad at myself for not doing the proper research.
Well in my case i think partial menisectony was necessary as i had bucket handle tear of my medial meniscus and my knee was locked.But i do have stiffness in my knee sometimes.Any suggestions to get rid of stiffness.
Hi Khalid,
Please see: https://regenexx.com/blog/can-you-treat-a-meniscus-tear-without-surgery/ When the stiffness occurs massaging the back of the knee may help, and if it does that suggests a particular issue, but we’d need to examine you to determine what’s going on in your case and suggest treatment. We have a Regenexx location in Mumbai and Hyderabad: https://regenexx.com/providers/regenorthosport/
I had meniscus tears in my knees when I was 17 and 18 years of age 1992 the surgeon for both operations removed my torn cartilage, I am 45 years of age now and have tri carpmental osteoarthristis in both knees and will need new knees before I am 50!!! They are only holding out with this procedure because of my age.
Hi Scott,
Sadly, despite the evidence, this surgery is still being routinely done. Our UK Provider may be able to help. Please see: https://www.algocells.com/?utm_source=regenexxreferral&utm_campaign=algocells
Meniscus tear, had surgery 13 yrs ago, very active running, cycling, golf etc. now right knee/leg have pain and inflammation in my knee and dule pain in my shine and back of knee. Bad enough to change quality of life. I’m 60, great shape at 195 lbs. MRI?
Hi Phil,
Unfortunately, menisucus surgery generally leaves the knee unstable which eventually causes other issues. Yes, MRI needed. Once done, please submit the Candidate form here: https://regenexx.com/conditions-treated/knee/