MRI Meniscus Tear Study Totally Misses the Point-Most Meniscus Tears should not be Surgically Treated

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A recent MRI study of meniscus tears showed that radiologists weren’t very good at determining which tears were best suited for arthroscopic trimming or repair. Huh? As I have blogged before, the data doesn’t support that surgery is a good idea for most meniscus tears in the first place, so a study that looks at how good or poor MRI is in telling surgeons if they will have to trim the meniscus or suture it, makes little sense when compared against the published research. A review of these meniscus tear and surgery studies is telling. First, arthroscopic, surgical debridement of a knee (the most common knee surgery currently performed, which includes trimming the meniscus and loose pieces of cartilage), was found to be no more effective than a placebo surgery. In addition (in the previous link) another study showed that meniscus tears are equally common in middle aged patients with knee pain and those without knee pain. This begs the question whether in most middle aged patients, a meniscus tear is even relevant as something that causes pain, let alone whether we should be operating on these tears. Now add in studies showing that cutting out pieces of the meniscus only leads to the onset of knee arthritis. How about another research study showing that when these knees with meniscus tears and stretched or torn ligaments are operated with arthroscopy, they still get arthritis the same as when they’re not operated? Here’s one that showed that treating a degenerative meniscus tear with arthroscopic knee surgery fared no better than just leaving the tear alone? How about yet another study that showed that when certain meniscus tears were sutured using arthroscopy, not many actually healed. How about this one (just published), showing that partial menisectomy (the arrthoscopic trimming of the meniscus discussed above) results in changes in knee biomechanics that lead to more joint contact and that this likely explains the faster onset of arthritis in knees that have had this surgery. In summary, surgery for meniscus tears, while common practice, isn’t supported by the totality of the published research.

Tears don't always cause pain. Get a Regenexx® Second Opinion on your MRI and avoid unnecessary surgery.
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

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