Meniscus Surgery Recovery: A Powerful Visual
Meniscus surgery recovery? Can you ever truly recover from parts of your knee meniscus being removed surgically? This morning I was searching for last minute visuals for the upcoming Vatican stem cell conference when I came across a graph that was just too powerful to ignore. An orthopedic research group in the 1980’s performed a simple experiment, surgically removing parts of the meniscus and checking joint contact stress to see how this might effect meniscus surgery recovery. Sure enough, they found what others have since reported, the more meniscus you surgically remove the worse you make the knee joint. Take a look at the graph I recreated from the 1980’s paper (above). Note that just removing up to 10% of the meniscus can increase joint stress about 70% (i.e. removing just a tiny part of the all important meniscus spacer increases the wear stress on the cartilage and reduces meniscus surgery recovery). Once you remove >50% of the meniscus through surgery the amount of stress on the joint exponentially explodes and the likelihood of recovery drops further! How does this graph fit in the context of most modern meniscus surgeries? We see surgeons routinely remove between 10-40% of the meniscus during a patient’s first meniscus “repair” surgery (this term “repair” is a misnomer in that cutting something out is termed “repair” in no other area of medicine). So this means that the first meniscus surgery increases cartilage wear stress by approximately 40-70%. In addition, the remaining meniscus often fails as it now has the same forces (body weight) being borne on a smaller amount of tissue, which leads to the second knee surgery. In the second meniscus surgery, we routinely see 20%-70% of the meniscus removed (cumulative). This then increases the knee joint stress approximately 50-250% over normal. Is it any wonder why these patients never truly recover from knee meniscus surgery and instead just slowly accumulate more and more knee arthritis? In the end, after a number of years these patients make their way into our offices with much of their knee cartilage gone and wondering why it happened. The graph above shows very succinctly why they lose cartilage. The upshot? Meniscus surgery recovery may be a misnomer in itself, as the more knee meniscus you remove, the more cartilage the patient loses and the less likely that the patient can ever recover from meniscus surgery. As a result, we now routinely recommend to patients who show up to our clinic with their first painful meniscus tear to consider non-surgical alternatives such as platelets and stem cells.