Should I Have Meniscus Surgery? No…

By Chris Centeno, MD /

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should I have meniscus surgery

The most common orthopedic surgery in America had it’s final epitaph written this month with a level-1 study showing that surgery for meniscus locking is no better than placebo. Given that this was the final indication for the surgery, based on the research, to use a party analogy, the booze has run out for this little soiree. So if you’re asking yourself, “Should I have meniscus surgery?” the research on the topic has now spoken, and the answer is a resounding “NO!!!”

What Is a Meniscus Tear?

The meniscus is a natural shock absorber in the knee that provides some spring in your step and helps to protect cartilage. It can become torn with age or trauma, and greater than 90% of the surgeries on the structure are not repairs, as most patients believe, but are instead excisions, or cutting out, of the torn part of the meniscus.

Meniscus Tears in Middle Age Are like Wrinkles—Everybody Has Them

The big misconception that has been propagated like a “scandalous” rumor in a small town is that meniscus tears as seen on MRI after a middle-aged patient reports knee pain are significant. THEY ARE NOT. Just as many of your middle-aged friends who don’t have any knee pain or problems have meniscus tears; hence, the fact that your MRI has one is as important as those new wrinkles on your forehead in need of a little Botox.

The Research Showing Meniscus-Tear Surgery Doesn’t Work

The first canary in the meniscus surgery coal mine happened way back in 2002, when a study by a Baylor College of Medicine orthopedic surgeon showed that debridement (the cleaning up of a knee that has arthritis and degenerative meniscus tears) was no better than a placebo. After many surgeons published comments that in medical parlance equated to wanting to blow up the poor guy’s car, the procedure over the last 15 years has slowly slipped into medical oblivion.

The next study came from an unlikely source; turns out the Framingham, Massachusetts, town that has given us such great heart data through the years also has a government-sponsored osteoarthritis study. This and other studies concluded that just as many middle-aged people without knee pain had meniscus tears as those with knee pain. Ouch…

In 2012 a large high-level research study published in the New England Journal of Medicine showed that on average, patients who had meniscus surgery didn’t do any better than those who skipped the surgery and just had physical therapy. Many orthopedic surgeons criticized the study by saying that these patients had some arthritis and that there was still a justification for performing the procedure on patients with a meniscus tear without arthritis. That fantasy went “bye bye” in 2013 when a high-level study showed that meniscus surgery in patients without arthritis was no better than a fake surgical procedure. There was still one condition left where meniscus surgery might be helpful—a meniscus tear that was causing locking of the knee. However, a new study out this month just burst that bubble!

The New Study Puts the Final Nail in the Meniscus Surgery Coffin

The new study out of Finland looked at 146 patients who had “mechanical symptoms” (i.e., locking or catching thought to be caused by the meniscus). They randomized about one-half of the patients to meniscus surgery, and about half got a sham surgery. They found that the surgery provided no benefit to relieve knee catching or occasional locking, and they cautioned against patients getting the surgery.

Now, I know surgeons will argue that there still may be a justification for the surgery in patients with severe frequent locking of the knee or in patients who are younger and have an acute meniscus tear. In the first instance, they may be right, and in the second, given that studies have shown a rapid onset of arthritis and increased forces on the cartilage after a meniscus surgery, I would caution that the circumstantial evidence is that surgery should be avoided in those patients as well.

The upshot? It was a heck of a party while it lasted. However, not only has the booze run out, but someone has turned on the god-awful lights, and the after-party has been cancelled. Uber drivers have been called, and the hosts are showing us the door. In other words, there is little scientific justification at this point in patients 35 and older that operating on their torn meniscus will do any good, and it’s only a matter of time until insurers and national healthcare systems begin relegating this procedure to the dustbin of medical history. So if you’re asking yourself, “Should I have meniscus surgery?” answer yourself with a resounding “NO”!

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23 thoughts on “Should I Have Meniscus Surgery? No…

  1. Brian

    I agree 100% with this article !! I had meniscus surgery on August 18, 1015 and have only got worse since then. I wish I never had it done. I was advised it was this or a knee replacement, of course I selected surgery ! Then it was 5 injections of Supartz, this turned out to be another mistake, but once again its this or a knee replacement ! I am now awaiting the Regenexx procedure…..hoping this is not my third mistake !

    1. Regenexx Team Post author

      Brian,
      Meniscus surgery so often leads to instability and arthritis, and Supratz is a lubricant with no regenerative potential. Given the choices you were given anyone would have made the same 2 choices, but so glad you had the courage to make a third choice!

  2. Laurie M

    I had this procedure done I October 2015. My knee feels so much better!!! Thankful to have found Regenexx.

    1. Regenexx Team Post author

      Laurie,
      So glad your knee is doing so well!

  3. deb

    I had PRP by a Regenex provider in October of 2015 on one of my knees with great results. Would now like to try my it on my other knee.

    1. Regenexx Team Post author

      Deb,
      Great to hear! Intervening early can only ever be a good thing.

  4. Elmo Glick

    Of course, given the fact that regenerative therapies are not covered under medicare or insurance, these therapies are only available to the wealthy. That leaves most of us with little alternative than to try repeat cortisone shots, PT, NSAIDs or to suffer.

    1. Regenexx Team Post author

      Elmo,
      We too wish these therapies were covered by insurance. But in the meantime there are things you can do: Avoid the steroid shots! They are very damaging to the stem cells that are naturally in your knees. PT is great, as a matter of fact it’s been found to be better than meniscus surgeries. Eat a low glycemic diet, as blood sugar issues are also bad for the stem cells already present in your knees, and they are the repairmen of your body. Fish oil is much better than NSAIDS for inflammation without the cardiac and other risks, and Resveratrol and Chondroitin and Glucosamine are good for cartilage protection. http://www.regenexx.com/blog/supplement-for-cartilage-protection/

  5. Clinton Bradley

    People really need to understand that arthritis is in fact an autoimmune condition that can be entirely avoided and cured through nutrition – i.e. switching to a plant based diet. My wife had chronic rheumatoid arthritis at age 40 and was on a cocktail of immunosuppressive drugs which caused all kinds of side effect havoc. She was cured of the condition and the side effects within a few months by switching to a whole food plant based vegan diet without drugs of any kind. This is just one of the many well established benefits of a plant based diet. I am also on vegan diet and have seen many benefits.

    I had surgery for a meniscus tear a decade ago and still experience some pain when applying a lot of force on it while cycling steep hills and I still have a general mild pain but it’s not too bad. I do wish Regenexx had been available then.

    1. Regenexx Team Post author

      Clinton,
      That’s wonderful that your wife was able to get off the immunosupressive drugs with diet…what we put in our bodies is huge! From the point of view of stem cells it’s important to eat a low glycemeic diet which can be achieved with a vegan diet as well. A good percentage of our knee patients have had prior meniscus surgery, which is why they need treatment now. It’s not too late! http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/

  6. jeff

    I had a mri on my right knee and it shows that i have a meniscus tear on the inside of my right knee . I only had pain when it tore while running no swelling . But now i have a baker cyst that is bothering me . Could the regenexx porcedure help that thanks jeff

  7. Sharon B.

    I had meniscus surgery 6/2006. It was repair plus “plugs”/biosynthetic matrices. The dr. spent 5” telling me what he would do. He said “plugs.” I could not find anything on it since I did not have the medical term. It was not a good thing to do. I was on crutches 6 weeks, no weight bearing. At my age, that is not good for a muscle. I had 6 hyaluronic injections (no help) and then told to have knee replacement. My sister saw your article in Good Housekeeping 2009 and told me about it. March 2010 I had one injection of stem cells in Broomfield. It stabilized my knee. My culture did not make enough for more injections. I knew I was not a good risk.

    I found out that there is a dr. in Tulsa that does Regenexx. Sept. 2015 I had PRP in my SI, lumbar, and cervical joints. It really helped my back pain. I have had some feeling back in my hand. Jan. 1016 I had PRP injections in my neck. It is helping some. I will give it more time. I have been told I need to have 3 cervical joints fused. Unfortunately, I fell hitting my tailbone and head loading firewood. I hope that does not mess up the injections I had in the lumbar area. I need to realize I am not 60 anymore. I am 68.

    1. Regenexx Team Post author

      Sharon,
      My goodness, you’ve been through a lot! The fall should not mess up your lumbar injections from 9/15, though any fall could cause new injury. If at all possible, it’s a good idea to avoid the cervical fusion, as in not too long they end up putting additional load and stress on the vertebrae above and below the fusion. You are in good hands with Dr. Movva!

  8. Bob Eberhardt

    I’ve had both knees scoped (2005, 2009 partial tears) and it alleviated the pain (which was not minor) and allowed me to run again. I’m at a point now where I’m starting to experience knee pain again and, if it happens to be meniscus related, would like explore a stem cell procedure. Will the previous surgeries have any bearing on the possible success of a stem cell procedure?

    1. Regenexx Team Post author

      Bob,
      A knee that has had no previous intervention of any kind in a patient with no health problems on no medication who is a perfect physical specimen would be wonderful…but we’ve seen very few of those! A good percentage of our patients have had prior surgeries, and it’s the instability and arthritis that results from those that bring them to us. So, not a problem. http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/

  9. Lynda Ward

    I have had miniscus surgery and one series of fSupartz, five injections. Not happy with the results. Would stem cell injection still possibly work for me?

    1. Regenexx Team Post author

      Lynda,
      A good percentage of our knee patients have had a meniscus surgery so not a problem. Supartz is a lubricant but has no regenerative potential. Luckily, Supartz injections do not negatively affect stem cell treatment. The thing to avoid are steroid shots! http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/

  10. Donna

    I had PRP treatment on my knee for a torn meniscus and a partially torn patella tendon and it worked great . My ortho Doctor said try PRP before major surgery. If you can afford PRP try it first .

    1. Regenexx Team Post author

      Donna,
      Your Ortho Doctor gives spot on advice!

  11. Anna

    Thanks for sharing about meniscus surgery.

  12. Mark Hayes

    I have had knee pain for about 8 months, which in the beginning was especially bad after staying in a position with my knees bent and then standing. After a cortisone injection and PT, my knees and back were better. About 2-3 months ago the right knee started hurting again, and despite another cortisone injection (which my orthopedic doctor said was my last) the pain has gotten worse. The medial side of the knee hurts, when I stand and even at night when the knee lies on my other knee (or the other way around). I got an MRI and it confirmed a tear in the meniscus, and I have got to do something for the pain. When I hit my foot on anything, the pain is sharp and severe. I go to talk to my doctor tomorrow for options. I will ask about this treatment, just to see what the response is.

    1. Regenexx Team Post author

      Mark,
      Other than meniscus surgery, the most important thing to avoid are steroid shots. While they can give temporary pain relief they are a significant net negative as they kill stem cells, breakdown cartilage, and can damage tendons. Please see: https://regenexx.com/blog/steroid-injection-risks/ and https://regenexx.com/blog/steroid-shots-for-knee-arthritis/ The meniscus tear might or might not be your source of pain as other than bone marrow lesions, there is very little connection between structural MRI findings and knee pain. Please see: https://regenexx.com/blog/surgery-controlled-damage-accomplish-goal/ and https://regenexx.com/blog/orthopedic-civil-war-begins/ and https://regenexx.com/blog/knee-meniscus-surgery-increases-odds-knee-replacement/ and https://regenexx.com/blog/knee-bone-marrow-lesions-why-bmls-are-the-mri-lesion-nobody-has-ever-mentioned/ https://regenexx.com/blog/knee-arthritis-nerve-pain/

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.
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