When patients get a knee MRI and see they have a lateral meniscus tear, it rocks their world. Rather than a lateral meniscus tear surgery alternative, often the first thing they think of is surgery. After all, doesn’t surgery fix the tear? So why wouldn’t your lateral meniscus tear recovery plans include surgery? Because the research doesn’t support that surgery will help you, but instead may hurt you. Let me explain.
First, all meniscus tears, including tears of the lateral meniscus, are as common as grey hair or a middle aged beer belly. According to large studies, there are as many pain free middle aged or elderly patients walking around with meniscus tears than without. Therefore just because a lateral meniscus tear was seen on MRI doesn’t mean that it’s causing any pain or problems. Second, >90% of the time, there is no such thing as a surgery to fix the tear, in fact the surgery that’s performed cuts out the torn part of the meniscus instead, leaving less of the important structure to absorb shock. Third, the research on the outcome of meniscus surgery shows it’s no better than plain old physical therapy. Finally, a new study this year shows that the tear itself won’t lead to arthritis, but meniscus surgery might.
The recent study involved computer modeling of the wear forces on the joint and cartilage in a knee with a lateral meniscus tear. The researchers found that the torn meniscus didn’t increase the forces on the cartilage. This is a big surprise, as the rationale for getting rid of the tear by surgically removing pieces of cartilage is to help the knee function normally. This would include the reduction of long-term wear and tear on the cartilage. If the torn meniscus isn’t putting more pressure on the cartilage, then why are we cutting it out? In fact, when the researchers looked at the effect of removing parts of the meniscus surgically to remove the tear, they did see significant jumps in wear forces on the cartilage that could lead to arthritis. What they did not find was increased forces on the meniscus itself with a tear, still keeping the door open for a therapy to treat the tear rather than cutting it out.
The upshot? Meniscus surgery hasn’t been shown to be helpful and a multitude of studies show that it may be harmful. So if you have a lateral meniscus tear, look at physical therapy first. If that doesn’t work, consider lateral meniscus tear surgery alternatives and biologic therapies like platelet rich plasma or stem cells before you consider letting someone whack out a part of your meniscus.